• Français

Medication history - BCM

What is a medication reconciliation – Medication History?

It is the complete list of prescription drugs, over-the-counter medications and natural health products that your child has taken at home in the past 2 weeks. All information provided by completing this document will be used to adjust your child's medication therapy during his stay at the hospital and after his discharge.

How to complete this document?

Document to be completed:
Medication history - BCM (PDF)

  • Write down all allergies and intolerances of your child. They can be caused by a medication, natural health product, food, plant, bandage, etc. An allergy involves redness of the skin, swelling and/or breathing difficulties. An intolerance is a side effect (e.g. stomach cramps) that doesn't require the discontinuation of product.
  • If you have the name and the phone number of your community pharmacy, please write it down.
  • Write all the information you have about your child's medications and others treatments. Include all products taken in the past 2 weeks, daily or not. Medications include tablets, capsules, inhalers, syrups, suppositories, drops, creams, gels, vaccines, etc.
  • Don't forget "over-the-counter" medication (non-prescription drugs) and natural health products (including vitamins, minerals, medicinal plants, homeopathic remedies, probiotics, amino acids, fatty acids, etc.)
  • If your child is not on any medication or any other product, please write down "No medication".
  • Your signature is important. Write the date as well.

Who do I have to hand back the form to?

  • When you arrive with your completed form Medication history - BCM to the hospital, you can give it to a nurse or a physician during your child's evaluation.
  • A staff member may see you again in order to clarify information reported in the document.

Thank you for your participation.

About this page
Updated on 10/8/2014
Created on 7/11/2014
Alert or send a suggestion

Every dollar counts!

Thank you for your generosity.

It is thanks to donors such as you that we are able to accelerate research discoveries, to heal more children every year and to continue to offer world-class care.

It is also possible to give by mail or by calling toll-free

1-888-235-DONS (3667)

Contact Us

514 345-4931


© 2006-2014 CHU Sainte-Justine.
All rights reserved. 
Terms of Use,  Confidentiality,  Security


All information contained within the CHU Sainte-Justine site should not be used as a substitute for the advice of a duly qualified and authorized medical practitioner or any other health professional. The information provided on this site is intended for educational and informational purposes only.

Consult your physician if you feel ill or call 911 for any medical emergency.

CHU Sainte-Justine