I. Was the medication administered?*

II. Date of medication*

Date of medication*

1.1. ACE inhibitor*

1.2. AT1-receptor antagonist*

1.3. Aliskiren*

1.4. Beta blocker*

1.5. Other antiarrhythmic agent*

Please specify*

1.6. Thiazide*

1.7. Loop diuretic

1.8. Aldosterone antagonist*

1.9. Other diuretic*

1.10. Cardiac glycoside*

1.11. Nitrate*

1.12. Ranolazine*

1.13. Ca antagonist*

1.14. Amiodarone*

1.15. Ivabradine*

1.16. Statin*

1.17. Other lipid-lowering agent*

2.1. ASA*

2.2. Thienopyridine (prasugrel, ticagrelor, thienopyridines (e.g. clopidogrel))*

2.3. Vitamin K antagonist*

2.4. New oral anticoagulant (NOAC)*

3.1. Insulin*

3.2. Oral antidiabetic drug*

4.1. NSAIDs*

4.2. Anti-obstructive pulmonary disease drug*

4.3. Antidepressant*

4.4. Soporific/sedative agent*

4.5. Others*

5.1. Oral contraceptive*

5.2. Hormone therapy*