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Medication Knowledge
Assessment Form

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(Instructions for use)

The Medication Knowledge Assessment is used to assess a person's knowledge and ability to read and comprehend information necessary for appropriate medication use. Information from the Medication Knowledge Assessment can serve as the basis for a focused knowledge improvement plan.

On the day the Medication Knowledge Assessment is to be conducted, the person should be asked to have all their medication containers available.


Using the Medication Knowledge Assessment Form, write the name of each medication name in the left column, then ask the person the following questions about each of their medications.

  1. Name of the medication. (Can the person read the label?)
  2. Why are you taking the medication? (For what disease or condition?)
  3. How much are you taking? (Number of pills)
  4. When to take the medication? (E.g., morning, before meals, twice a day)
  5. Effects to look for. (Both positive and negative)
  6. Where do you keep the medication? (To ascertain special storage conditions)
  7. When is the next refill due? (And plan or method for obtaining refills.)

Place a check mark next to each question that the person can correctly answer.

Use the results from the assessment to identify knowledge gaps and develop a knowledge improvement plan.