HERBAL PRODUCT PHARMACIST VISIT: THREE-CARD PREPARATION RECORD
Blank information aid, not an interaction screen or dosing guide.
Keep a completed copy private; this website does not collect answers.

CARD 1 — THE EXACT HERBAL PRODUCT
Product name and manufacturer:
Package / label language:
Form: food, tea, powder, capsule, extract or other:
Ingredients copied exactly; include other ingredients:
Plant names / plant parts if stated:
Printed serving amount and unit:
Amount listed per serving:
Blend total / individual amounts not provided:
Directions and warnings copied from the package:
Batch or lot / expiry if available:
Original package or clear label photos available:
Purpose I am considering it for:
Status: not started / currently used / stopped:
Missing or unreadable information:

CARD 2 — WHAT I ACTUALLY USE
Prepared date:
For EACH prescription, over-the-counter medicine and supplement:
Exact name and formulation:
Label / prescribed strength and unit:
Actual amount per occasion:
How often; regular or occasional:
Usual timing and most recent use if relevant:
Start / stop date if known:
Differences from the printed directions:
Unknown details to check:
Other herbal products, vitamins or relevant drinks:
Allergies and previous reactions to discuss:
Health conditions / pregnancy / nursing / child context:
Planned procedure and date if relevant:
Changes or symptoms and their timing:

CARD 3 — QUESTIONS AND THE AGREED NEXT STEP
Main question and purpose:
Can you identify this exact product and its ingredients?
Which of my medicines or other products need checking?
What evidence is known, uncertain or not applicable?
Does my health context change the assessment?
Who needs to review an unresolved question?
Advice given; record the professional's exact instructions:
Any monitoring or follow-up they recommend:
Person / team responsible:
When and how to follow up:
What remains unresolved:
Who else in my care team needs this updated list:

TWO FICTIONAL EXAMPLES — NOT DOSE RECOMMENDATIONS
A: Printed serving 2 capsules; blend total 600 mg; three listed ingredients with separate amounts not provided. Actual use: 1 capsule once yesterday. Do not invent an equal distribution or rewrite actual use to match the label.
B: An occasional tea sold as a warming blend has an unreadable ingredient panel and an unknown leaf amount. Record those gaps; the category does not identify the product.

ATTRIBUTED EVIDENCE EXAMPLES — NCCIH DECEMBER 2024 DIGEST
Ginkgo with warfarin: associated with increased major bleeding risk compared with warfarin alone.
Asian ginseng with warfarin: mixed study results.
High-dose green tea with nadolol: reduced blood levels and effectiveness.
These examples are not a complete database or personal clearance. Keep the exact product and care context; do not infer a dose or timing change.

SIX ORIGINAL CASES
Case 1: A package states a two-capsule serving, but you took one capsule once yesterday. Which number belongs in actual use?
Answer: One capsule once yesterday; retain the printed two-capsule serving separately.
Explanation: The package statement and your history answer different questions. Recording what happened does not endorse that amount. Give the pharmacist both details rather than replacing the history with a label-directed daily schedule.

Case 2: A fictional three-herb blend states 600 mg total but no separate ingredient amounts. Can you record 200 mg of each herb?
Answer: No. Keep the 600 mg total and mark individual amounts as not provided.
Explanation: An equal division is an invented composition. The label does not show how that total is distributed or identify an appropriate dose. Bring the complete package and ask what further information is needed.

Case 3: You take no prescription medicines but occasionally use cold remedies and another supplement. Should the list say “nothing else”?
Answer: No. Include the occasional over-the-counter products and supplement.
Explanation: NCCIH advises a complete medicine and supplement list with amount and frequency. Record occasional use honestly and bring containers when details are uncertain; prescription-only status is not a complete history.

Case 4: Your tea packet has an unreadable ingredient panel and a warming description. Does the traditional category identify its ingredients?
Answer: No. Keep the category separate and record the missing product details.
Explanation: A traditional description does not supply a species, preparation or amount. Preserve the packet or a readable original-language source for identification, rather than guessing an ingredient list from the category.

Case 5: The three-example table does not mention your herb. Does absence mean that it is suitable with your medicines?
Answer: No. The table is an illustration, not an exhaustive interaction assessment.
Explanation: Bring the exact product and complete list for professional review. NCCIH describes both documented interactions and uncertainty; absence from a short article provides no individual clearance or timing solution.

Case 6: A pharmacist previously discussed one extract. You now have another formulation and a changed medication list. Can you carry the earlier conclusion over unchanged?
Answer: Do not assume it applies unchanged; present the new details for review.
Explanation: The exact product and care context are part of the question. Retain the previous advice accurately, identify what changed, and ask about an appropriate updated assessment and follow-up instead of treating the brand name as permanent approval.

VERIFIED SOURCE PAGES
https://www.nccih.nih.gov/health/know-science/how-medications-and-supplements-can-interact/talk-with-your-health-care-providers
https://www.nccih.nih.gov/health/providers/digest/herb-drug-interactions
https://www.nccih.nih.gov/health/traditional-chinese-medicine-what-you-need-to-know
https://www.nccih.nih.gov/health/know-science/how-medications-and-supplements-can-interact/tips-on-reading-supplement-labels