A medication log sheet that fills itself in with your AI

Updated 2026-10-30

Memory is a poor record of what you took last Tuesday. I would rather note each dose in one form the moment it happens. The list then comes out as a table, with no handwriting to decode.

Before the day

Pick who logs: the person who takes the medicine, a family member or a carer. Share the one public link, and save it on the phone home screen. Ask them to use the same name for each medicine, so the CSV sorts well.

During the day

Each dose gets one entry. The log asks for the date, the time of day, the medicine and the dose. Then it asks how it went: on time, late, skipped on purpose or forgot. A short list of side effects and a free note catch anything odd. A refill box warns that the box is running low.

A person's AI might ask "Which medicine did you take?" Then "Did you take it on time?" Then "Did you notice any dizziness?" It shows all answers and sends only after a yes. See agent-fillable forms.

After a week or a month

Download the CSV. Count the late and missed doses, and bring the list to the next visit. A doctor or pharmacist can read the pattern. Do not change a dose because of this list.

Check your local privacy rules before collecting health data. This is a form, not medical advice. It pairs with a food diary and a blood pressure log. More in forms for clinics.

Questions

Can the form remind me to take a dose?

No. It does not send reminders. It only records what you enter. Use your phone alarm for reminders and use this form to keep the history in one list.

How can a carer log doses for someone else?

The carer picks A carer in the logged_by question, then fills one entry per dose. The CSV shows who logged each row, so the family can see the whole picture.

How do I track a missed dose pattern?

Download the CSV and filter taken_as_planned for Forgot or Skipped on purpose. Then sort by dose_slot to see if one time of day causes the problem.

Try the form

Live demo ยท nothing is saved

Log a dose

Add one entry for each dose you take or miss. Write what happened, and nothing more is needed.

Time of day (required)

For example one tablet or 5 ml.

How did it go? (required)
Taken with food
Did you notice any of these?
I am running low and need a refill
Who is logging this?
Use this templateAll templates

Or paste the JSON

Give this to your AI. It needs the AI Form API MCP server or an API key. It makes the form and sends you the link.

text
Create this form with the AI Form API create_form tool (or POST https://aiformapi.com/v1/forms with my API key). Then reply with the public_url.

{
  "title": "Log a dose",
  "description": "Add one entry for each dose you take or miss. Write what happened, and nothing more is needed.",
  "fields": [
    {
      "id": "dose_date",
      "label": "Date",
      "type": "date",
      "required": true
    },
    {
      "id": "dose_slot",
      "label": "Time of day",
      "type": "single_choice",
      "required": true,
      "options": [
        "Morning",
        "Midday",
        "Afternoon",
        "Evening",
        "Bedtime"
      ]
    },
    {
      "id": "medicine_name",
      "label": "Which medicine?",
      "type": "short_text",
      "required": true,
      "max_length": 200
    },
    {
      "id": "dose_taken",
      "label": "Dose taken",
      "type": "short_text",
      "help": "For example one tablet or 5 ml.",
      "max_length": 100
    },
    {
      "id": "taken_as_planned",
      "label": "How did it go?",
      "type": "single_choice",
      "required": true,
      "options": [
        "Taken on time",
        "Taken late",
        "Skipped on purpose",
        "Forgot"
      ]
    },
    {
      "id": "with_food",
      "label": "Taken with food",
      "type": "checkbox"
    },
    {
      "id": "side_effects",
      "label": "Did you notice any of these?",
      "type": "multi_choice",
      "options": [
        "Nausea",
        "Dizziness",
        "Drowsiness",
        "Headache",
        "Upset stomach",
        "Rash",
        "Nothing at all"
      ]
    },
    {
      "id": "side_effect_note",
      "label": "Tell us more about anything you noticed",
      "type": "long_text",
      "max_length": 800
    },
    {
      "id": "refill_needed",
      "label": "I am running low and need a refill",
      "type": "checkbox"
    },
    {
      "id": "logged_by",
      "label": "Who is logging this?",
      "type": "single_choice",
      "options": [
        "Myself",
        "A family member",
        "A carer"
      ]
    }
  ]
}

Or call the API

bash
curl -X POST https://aiformapi.com/v1/forms \
  -H "Authorization: Bearer $AIFORMAPI_KEY" \
  -H "Content-Type: application/json" \
  -d '{"title":"Log a dose","description":"Add one entry for each dose you take or miss. Write what happened, and nothing more is needed.","fields":[{"id":"dose_date","label":"Date","type":"date","required":true},{"id":"dose_slot","label":"Time of day","type":"single_choice","required":true,"options":["Morning","Midday","Afternoon","Evening","Bedtime"]},{"id":"medicine_name","label":"Which medicine?","type":"short_text","required":true,"max_length":200},{"id":"dose_taken","label":"Dose taken","type":"short_text","help":"For example one tablet or 5 ml.","max_length":100},{"id":"taken_as_planned","label":"How did it go?","type":"single_choice","required":true,"options":["Taken on time","Taken late","Skipped on purpose","Forgot"]},{"id":"with_food","label":"Taken with food","type":"checkbox"},{"id":"side_effects","label":"Did you notice any of these?","type":"multi_choice","options":["Nausea","Dizziness","Drowsiness","Headache","Upset stomach","Rash","Nothing at all"]},{"id":"side_effect_note","label":"Tell us more about anything you noticed","type":"long_text","max_length":800},{"id":"refill_needed","label":"I am running low and need a refill","type":"checkbox"},{"id":"logged_by","label":"Who is logging this?","type":"single_choice","options":["Myself","A family member","A carer"]}]}'

JSON definition

json
{
  "title": "Log a dose",
  "description": "Add one entry for each dose you take or miss. Write what happened, and nothing more is needed.",
  "fields": [
    {
      "id": "dose_date",
      "label": "Date",
      "type": "date",
      "required": true
    },
    {
      "id": "dose_slot",
      "label": "Time of day",
      "type": "single_choice",
      "required": true,
      "options": [
        "Morning",
        "Midday",
        "Afternoon",
        "Evening",
        "Bedtime"
      ]
    },
    {
      "id": "medicine_name",
      "label": "Which medicine?",
      "type": "short_text",
      "required": true,
      "max_length": 200
    },
    {
      "id": "dose_taken",
      "label": "Dose taken",
      "type": "short_text",
      "help": "For example one tablet or 5 ml.",
      "max_length": 100
    },
    {
      "id": "taken_as_planned",
      "label": "How did it go?",
      "type": "single_choice",
      "required": true,
      "options": [
        "Taken on time",
        "Taken late",
        "Skipped on purpose",
        "Forgot"
      ]
    },
    {
      "id": "with_food",
      "label": "Taken with food",
      "type": "checkbox"
    },
    {
      "id": "side_effects",
      "label": "Did you notice any of these?",
      "type": "multi_choice",
      "options": [
        "Nausea",
        "Dizziness",
        "Drowsiness",
        "Headache",
        "Upset stomach",
        "Rash",
        "Nothing at all"
      ]
    },
    {
      "id": "side_effect_note",
      "label": "Tell us more about anything you noticed",
      "type": "long_text",
      "max_length": 800
    },
    {
      "id": "refill_needed",
      "label": "I am running low and need a refill",
      "type": "checkbox"
    },
    {
      "id": "logged_by",
      "label": "Who is logging this?",
      "type": "single_choice",
      "options": [
        "Myself",
        "A family member",
        "A carer"
      ]
    }
  ]
}