Donatien L Musamu

Experienced in assembling carts and selecting instruments and supplies for procedures. Competent in performing and documenting test results, restocking supplies and managing records. Focused on working quickly and accurately to maintain efficient facility operations. Detail-oriented Sterile Processing Technician with over [Number] years of related experience. Excellent verbal and written communication skills with hardworking and diligent nature.

• Page 1 of 2February 2021
• Personal Medication List
• A list of all the medications you take is very important for the doctors and the healthcare team at the cancer centre
• Please fill out this form no more than 2 days prior to your first appointment
• Remember that vitamins, minerals and herbal or natural products are also important to list
• Please bring your completed form, along with all your bottles for vitamins, minerals and herbal or natural products with you to your first appointment
• If your Medication Review is scheduled over the telephone, please have this sheet with you when you are called
• If you can’t complete this form for any reason, a pharmacy staff member will help you do this at your first appointment
• Name: Health card number: Allergies: List everything you are allergic to and the symptoms of your allergicreaction
• Name of substance E.g
• Penicillin, peanuts, latex Type of reaction E.g
• Rash, wheezing, lip swelling Check this box if you have no allergies Medications: List all types of prescription medications, non-prescription medications, vitamins, minerals, and herbal or natural products Name of prescription medications
• Medicines that your doctor prescribes, including those used only occasionally
• Strength
• E.g
• 50 mg
• Directions
• E.g
• 2 tablets in the morning or taken as needed
• Purpose
• Why do you take it? Check this box if you do not take any prescription medications
• Page 2 of 2February 2021 Name of non‐prescription medications
• Medicines purchased without a prescription, such as
• Tylenol, laxatives, allergy, cough and cold products
• Directions
• How do you use this medication? e.g
• Couple of times a week
• Purpose
• Why do you take it? Check this box if you do not take any non-prescription medications Vitamins, minerals, herbal or natural products
• E.g
• St
• John’s Wort, calcium, multi‐vitamins
• Brand name Ingredients
• Directions
• How do you take the product?
• Used for how long?
• Purpose
• Why do you take it? Check this box if you do not take any vitamins, minerals, herbal or naturalproducts
• Please provide any other comments regarding medications that will help your cancer care team:
• E.g
• Trouble opening child‐resistant containers or trouble swallowing tablets
• Date completed / / month day year
• Please email the completed form to patienthistory@saskcancer.ca and include your city/town in the subject line.