Missed Dose Log Template for GLP-1 and TRT Routines

Track missed doses without panic

Missing a dose happens. The key is to capture what happened clearly.

Use this missed-dose template

Log:

• medication name and route
• scheduled date and time
• actual date and time (if taken later)
• reason for the miss
• action taken based on care instructions

Add one prevention field

Every missed-dose entry should include:

• prevention change for next time

Examples:

• "Set backup reminder 1 hour later"
• "Refill reminder moved to 10 days before depletion"
• "Travel kit packed night before departure"

This turns each miss into a process improvement.

Focus on prevention, not blame

Use missed-dose entries to identify system issues:

• reminder timing problems
• supply refill delays
• travel or routine disruptions

Root-cause framework

Classify each miss into one category:

• memory (forgot)
• schedule conflict
• access/supply problem
• uncertainty about prior dose

If you see the same category twice, make one specific workflow change and review it after two weeks.

Keep guidance boundaries clear

Tracking helps you stay organized, but treatment decisions should come from your prescriber instructions.

Monthly missed-dose report

At month end, summarize:

• total misses by medication
• root-cause counts
• successful prevention changes
• unresolved risks to discuss with your clinician

A simple monthly report makes adherence trends clear without overcomplicating your routine.