Supplement/Herbal Recommendation Note

Date/Time: [Date and time of documentation]

Author/Credentials: [Author name and credentials]

Encounter Date: [Original encounter date] (Include only if documenting after the visit.)

Mode: [video / phone / portal message] (Include only if not a standard in-person visit.)

Clinical Context

[Primary indication or problem the supplement is intended to address]; [Patient-stated goals] (Use a brief direct quote when it clarifies intent.)

[Pertinent history: symptom duration, prior therapies tried and response]; [Relevant comorbidities affecting safety or dosing]; [Recent labs or vitals informing the recommendation]; [Current medications and supplements relevant to interaction risk]; [Relevant allergies] (Explicitly document information gaps rather than inferring.)

Recommendation

(For each product, document on a single structured line or short paragraph. Group by problem/goal if multiple products.)

• [Product/ingredient name]: [Formulation details and standardization if relevant]; [Brand or "any reputable third-party verified brand"]; [Dose and frequency]; [Timing and administration instructions]; [Start date]; [Planned duration or reassessment date]; Indication: [brief indication]. Rationale: [Brief link to clinical context]. Evidence: [strong / moderate / limited, based on source type]

(Repeat bullet for each additional product.)

Safety & Counseling

Contraindications reviewed: [Key contraindications considered, including pregnancy/lactation, organ impairment, bleeding risk as relevant]

Interactions: [Drug–supplement or supplement–supplement interactions identified and mitigation steps] (State "none identified" only if explicitly reviewed.)

Peri-procedural plan: [Hold instructions and notification to procedural team] (Include only if upcoming procedure planned.)

Patient counseling: [Administration instructions; expected side effects; red-flag symptoms for discontinuation; what to self-monitor]. Shared decision-making occurred and patient understanding confirmed.

Plan

Monitoring: [Parameters to track, frequency, and timing]

Follow-up: [Timeframe and modality]

Reassessment/stop criteria: [Defined trial period; adverse effect thresholds; new contraindications]

Medication list updated: [yes / no] (If no, state reason.)

Care coordination: [Communications to other clinicians] (Include only if applicable.)

(Omit items not addressed rather than leaving placeholders.)