Abstract:
The present invention provides a management system and method for using same that is simple, reliable and extremely easy to use. It comprises a label having a plurality of raised tabs that are depressed upon the occurrence of an event such as taking medication to provide a tactile and a visual record of medication use. It can be secured to a medication container or other object, and thus is not subject to being misplaced or forgotten. The system can be integrated with a pharmacy&#39;s computerized pharmaceutical record and prescription label printing system or it can be a stand-alone paste-on label. Alternatively, it can be used in combination with pill-dispensing packs to dispense medication while maintaining a record of use. The label can be in the form of an overlay, which is placed over a preprinted container or a container having a prescription label. The use of a pressure sensitive releasable adhesive permits the removal of the overlay label in the event that is it necessary to read information on the underlying label. The underlying label is provided with a plurality of raised tabs that correspond to the number of doses to be taken per day and the number of days for which the medication is to be taken.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     The present application claims priority to U.S. application Ser. No. 10/136,072 filed Apr. 30, 2002, which claims priority to U.S. provisional application No. 60/292,158 filed May 18, 2001 and to U.S. patent application Ser. No. 09/583,125 filed May 30, 2000, which claims priority to U.S. provisional patent application Ser. No. 60/136,796 filed May 29, 1999. This application incorporates by reference, as though recited in full, the disclosure of provisional application 60/292,158 and co-pending patent application Ser. No. 10/136,072. 
     
    
     BACKGROUND  
       [0002]     1. Field of the Invention  
         [0003]     This invention generally relates to a system and method for managing event occurrence, and more particularly a system and method for facilitating record keeping of events that occur over an extended period of time, and even more particularly to a system and method for aiding people in the correct administration and management of medication doses.  
         [0004]     2. Related Art  
         [0005]     It is well recognized that it is essential to assist people in establishing a medication regime, and to enable people to easily keep track of when and if medication has been taken. Numerous patents have proposed electronic reminder systems. One failing of the electronic systems is the high cost of the electronics. Another failing is their inability to note whether medication has been taken. Furthermore, they can be complicated in design and therefore difficult to operate. The emphasis of the electronic system is typically as a reminder mechanism, and thus no record is maintained of whether the medication was actually taken. The problem may be more severe in the case of the elderly and infirmed, but exists even in the case of those who are mentally alert. It is essential that the drug regimen be followed accurately and in a timely manner. Errors and misuse can undermine the effectiveness of medication and can be dangerous to the person using the medication.  
         [0006]     The problem is exacerbated when a person is using multiple medications during the same time period. Confusion can readily arise as to which medication was last taken, particularly, in those instances where the regimens differ for two or more of the medications. The need to keep track of a variety of different medication regimens has been well recognized. U.S. Pat. No. 5,261,702 proposes a system that includes a chart. The chart includes such information as the names of the medicines to be taken by a patient and coded symbols are marked on the chart. Times of the day are marked, printed, or otherwise placed on the chart. The coded symbols have distinctive varying shapes, such as circles, squares, triangles and the like. Additionally, various colors can be used to assist in the distinguishing between various medications.  
         [0007]     The &#39;702 patent also suggests the use of a laminated sheet, as for example a film plastic, so the marks can be easily erased. In one embodiment, a clear plastic surface is used so the sheet underlying the clear plastic surface would be visible and the coded symbols, horizontal rows, and vertical columns are visible. The chart is suggested as possibly being a ferrous material or a magnetic material so that the magnetic marking elements may be attached to the chart surface. In another embodiment, an adhesive can be provided so that the chart can be mounted on any surface.  
         [0008]     U.S. Pat. No. 4,815,767 is illustrative of another chart system for use in assisting a patient in tracking a medication regimen.  
         [0009]     A novel system for tracking medication use has been previously described by Kozlowski in U.S. patent applications Ser. No. 09/583,125 and Ser. No. 10/136,072. This application is incorporated by reference herein as though recited in its entirety. This system uses an overlay which can be added to the prescription label or printed separately. The overlay contains check boxes for the user to fill in with a mark to designate taking a pill over a set time period.  
         [0010]     Blister style packaging is also well known in the art and blister style packaging for medications is likewise well known in the art. The method and apparatus for forming blister style display packages has been disclosed in a variety of patents and other publications. It is known to seal articles in pockets that are formed and sealed in plastic windows of paperboard blanks. These blanks have one or more openings that are covered, on one surface, by a heat-deformable and heat-sealable plastic sheet. The pockets are formed by heating the plastic material extending across the windows and deforming this plastic material to form a blister. After the article is placed in the blister, the blister is closed, for example by folding the blank about a fold line and then heat-sealing the plastic material. As the plastic sheet or film which is used is generally transparent, the article is provided in a decorative package in which it is sealed but nevertheless is fully visible. The teachings are best described in U.S. Pat. No. 4,047,358 to Heffernan et al among others.  
       SUMMARY  
       [0011]     According to a first broad aspect of the present invention, there is provided a management system that is simple, reliable and extremely easy to use comprising a card or overlay with raised tabs that are pressed down after an event occurs such as a pill being taken. The plastic tab changes appearance from clear to opaque and changes shape from a rounded to a flattened surface, thus providing both a visual and a tactile indication. The term tab, as employed herein, includes pillbox, blister and similar shapes. The tab can have a flat or rounded top or other top contour. The device can be secured to a medication container or other object to reduce the likelihood of it inadvertently being misplaced or forgotten. The device can be integrated with a pharmacy&#39;s computerized pharmaceutical record and prescription label printing system or it can be a stand-alone paste on device. The device is preferably in the form of an overlay, which is placed over a preprinted container. The use of a pressure sensitive releasable adhesive permits the removal of the overlay label in the event that is it necessary to read information on the underlying label. Alternatively the device can be manufactured in clear plastic to permit reading of the prescription information through the device. The need to read the underlying label can be critical in the event of a person taking an overdose of a medication or a child inadvertently ingesting the medication. Additionally, being able to read the underlying label can be important when the patient desires to refill the prescription  
         [0012]     According to a second broad aspect of the present invention, the raised tabs of the management device comprise a raised surface having blister in the center of the raised surface and a dimple where the blister meets the raised surface to allow the tab to uniformly collapse when depressed.  
         [0013]     According to a third broad aspect of the invention, the device can be incorporated into a pill-dispensing card wherein the card contains the dosages incorporated within the blister and the card incorporates a raised tab and/or dimpled blister design to provide both the clear to opaque color change and the rounded to inverted tactile change. This enables the user to determine if a dosage has been taken, by both tactile and visual cues, providing an advantage for aged and infirmed patients. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]     The invention will be described in conjunction with the accompanying drawings, in which:  
         [0015]      FIG. 1  is a plan view of the device containing multiple raised tabs configured into a pill card design.  
         [0016]      FIG. 2  is a side view of the device in  FIG. 1 .  
         [0017]      FIG. 3A  is a close up side view of one embodiment of an intact raised tab of the device.  
         [0018]      FIG. 3B  is a close up side view of one embodiment of an intact dimpled blister of the device.  
         [0019]      FIG. 4  is a close up side view of a depressed blister of the device.  
         [0020]      FIG. 5  is a close up side view of a second embodiment of an intact dimpled blister of the device.  
         [0021]      FIG. 5   a  is a close up side view of a second embodiment of an intact dimpled blister of the device wherein the blister has a flat top surface.  
         [0022]      FIG. 5   b  is a top view of the dimpled blister of  FIG. 5   a.    
         [0023]      FIG. 6  is a perspective view of a medicine container having a medication management label of the present invention, affixed thereto.  
         [0024]      FIG. 7  is a perspective view of the medicine container of  FIG. 6  with the medication management label in partially peeled off status.  
         [0025]      FIG. 7   b  is a perspective view of a medicine container having a medication management label affixed at one end of the label.  
         [0026]      FIG. 8  is a plan view of a prescription label in combination with a medication management label.  
         [0027]      FIG. 9  is a plan view of a medication management label overlay.  
         [0028]      FIG. 10  is a plan view of an alternate embodiment of a medication management label in combination with a prescription label.  
         [0029]      FIG. 11  is a plan view of an alternate embodiment of the medication management label overlay in combination with a prescription label.  
         [0030]      FIG. 12  is a plan view of an alternate embodiment of the medication management label overlay in combination with a prescription label.  
         [0031]      FIG. 13  is a plan view of an alternate embodiment of a prescription label in combination with a transparent medication management label overlay positioned on, and partly covering the writing on an underlying label.  
         [0032]      FIG. 14  is a plan view of a four dose per day medication management label overlay.  
         [0033]      FIG. 15  is a plan view of a three dose per day medication management label overlay.  
         [0034]      FIG. 16  is a plan view of a two dose per day medication management label overlay.  
         [0035]      FIG. 17  is a plan view of a one dose per day medication management label overlay.  
         [0036]      FIG. 18  is a plan view of a one-month, single dose per day medication management label overlay.  
         [0037]      FIG. 19  is a plan view of a one-month, two dose per day medication management label overlay.  
         [0038]      FIG. 20  is a plan view of a three dose per day or three week single dose overlay, showing a Tuesday through Monday week.  
         [0039]      FIG. 21  is a plan view of a four dose per day or four week single dose overlay, showing a Friday through Thursday week.  
         [0040]      FIG. 22  is another alternative embodiment in which the overlay label is in the form of a roll of labels on a releasable substrate.  
         [0041]      FIG. 23  shows an alternate embodiment in which the overlay is applied to a box.  
         [0042]      FIG. 24  shows an alternate embodiment in which the overlay is applied over an underlying label that is affixed to a box.  
         [0043]      FIG. 25  shows an alternate embodiment in which the overlay is applied to a bottle, which can contain a liquid or pills.  
         [0044]      FIG. 26  is a further embodiment of the invention in which the overlay label is positioned on the container in a region that is substantially uncovered by the prescription label.  
         [0045]      FIG. 27  is a side view of the dimpled blister serving as a medication dispenser and containing a pill or tablet.  
         [0046]      FIG. 28   a  is a side view of an intact raised tab with one embodiment of an injection molded design.  
         [0047]      FIG. 28   b  is a side view of the dimpled blister of  FIG. 28   a  wherein the blister has been depressed.  
         [0048]      FIG. 28   c  is a top view of the depressed blister of  FIG. 28   b.    
         [0049]      FIG. 29   a  is a side view of an intact raised tab with a second embodiment of an injection molded design.  
         [0050]      FIG. 29   b  is a side view of the dimpled blister of  FIG. 29   a  wherein the blister has been depressed.  
         [0051]      FIG. 29   c  is a top view of the depressed blister of  FIG. 29   b.    
         [0052]      FIG. 30   a  is a side view of an intact raised tab with a third embodiment of an injection molded design.  
         [0053]      FIG. 30   b  is a side view of the raised tab of  FIG. 30   a  wherein the blister has been depressed.  
         [0054]      FIG. 30   c  is a top view of the depressed blister of  FIG. 30   b.    
         [0055]      FIG. 31  shows a side view of the raised tab of  FIG. 30   a  wherein one side of the blister has accidentally collapsed.  
         [0056]      FIG. 32  is a side view of an intact raised tab with a fourth embodiment of an injection molded design.  
         [0057]      FIG. 33  is a side view of the raised tab of  FIG. 32  wherein the blister has been depressed.  
         [0058]      FIG. 34  is a side view of the intact raised tab of  FIG. 32  wherein a pill is contained within.  
         [0059]      FIG. 35  is a side view of the blister of  FIG. 34  wherein the blister is depressed and the pill has been pushed through.  
         [0060]      FIG. 36  is a perspective view of a medication container having a punch-out plug medication label attached at one edge of the label.  
         [0061]      FIG. 37  is a perspective view of an I.V. reservoir having a medication management label attached. 
     
    
     DETAILED DESCRIPTION  
       [0000]     Description  
         [0062]     The management device of the present invention is applicable to manage a variety of event occurrences, especially events that occur over an extended period of time. Most preferably, the management device of the present invention is applicable to managing medication doses; however, the device can also be used to track chores and other everyday occurrences. For simplicity, since a medication management device is a the most preferred use, the invention will be discussed herein in terms of medication management, but is not meant to limit the scope of the invention.  
         [0063]     The medication management system of the present invention is preferably applied by the pharmacist to the medication container, or provided by the pharmacist, or at the pharmacy to the user, for application to the container. However, it can be applied by the manufacturer to the medication container, or provided by the manufacturer to the user, for application by the user. The system is readily employed by a pharmacy in combination with the pharmacy&#39;s computerized label printing system. The system is readily adaptable for institutional use, for example in nursing homes, hospitals, doctor&#39;s offices, veterinarian offices and the like. The device can have written guides on it to identify day of the week and dosage required or it can be of a plain design. Furthermore, these written guides can be in the form of Braille or raised letters for the visually impaired. The device provides an advantage over existing systems for tracking and/or dispensing medication in that both visual and tactile signals are provided for the user.  
         [0064]     Individuals can readily apply the device to their own medication containers. The device can be an overlay that is applied to a medicine container. In those instances where the bottle, or other form of container, is too small to separately accommodate both the pharmacy label, with its required information, and the medication regimen management label, the device is most advantageously easily removable, as for example, through the use of a releasable adhesive, as well known in the art. Alternatively, the device can be incorporated into blister packs to dispense the medication.  
         [0065]     Preferably, the overlay type of device is transparent, enabling a user to readily see information such as prescription name, name of the pharmacy, and the like. In a preferred embodiment, the pharmacy label is coordinated with the management system label, and attached by the pharmacist in combination with the prescription label.  
         [0066]     In another preferred embodiment the medication regimen label is attached to the container at only one edge of the label. This one edge attachment leaves the prescription label of the bottle totally accessible while still keeping the label to with the container. The edge having adhesive can be attached to any area of the container, but preferably is attached to a part of the container that does not obstruct the viewing of the prescription label. The remainder of the medication regimen label hangs freely. With this attachment configuration, the label can also serve as a flag that draws attention to the package, thereby decreasing the likelihood that the user will forget to take the medication. The label is preferably a bright, eye-catching color.  
         [0067]     The label adhesive should provide the required level of adhesion, either permanent or releasable, at the temperature typically found in refrigerators, since it is common to store medications at reduced temperature, or in cool environments.  
         [0068]     The information on the device preferably includes such information as medicine dosage options, time of the day for taking the medication, days of the week, and other desired information. The medicine dosage options can be, for example, daily, multiple times per day, as required, maximum usage, or occasional usage. Preprinted devices can be designed to start with any day of the week. This would serve to avoid the problem of the user inadvertently marking the label at the first day on the label, rather than with the first actual day of usage.  
         [0069]     The labels can be pre-printed in sets for sale in a retail establishment, such as a pharmacy. Alternatively, the pharmacist can provide the labels at the time of sale of a prescription medication.  
         [0070]     The releasable adhesive provides the most convenient and economical mechanism for enabling the user to peel off the label. Alternatively, a hook and loop system can be used. The hook and loop system is commonly available under the trademark VELCRO. In the case of a hook and loop system, either the hook element or the loop element can be on the container, and the other element is affixed to the label.  
         [0071]     Looking now to the Figures,  FIG. 1  illustrates the basic design of the medication record system, in this case, a card  10  containing several rows of raised tabs  12 . The card  10  can be manufactured from a variety of substances including flexible, transparent plastic and preferably contains an adhesive (not shown) covering at least a portion of the back of the card, allowing it to be positioned and affixed to a desired substrate. The card  10  can also have score lines or perforations  14  between each raised tab  12 , enabling the user to remove one or more rows of raised tabs or individual raised tabs in order to customize their medication management. The perforations enable the user or provider of the labels to customize the label to correspond to the number of doses per day and the number of days for the medication period. Preferably, however, the manufacturer can make medication regimen labels corresponding to different required doses. Thus, 3 doses a day for 8 days would correspond to three rows by eight rows of tabs.  FIG. 2  shows a side view of the management card shown in  FIG. 1 . The card  20  and raised tabs  22  are shown in profile and the adhesive backing  26  is now visible.  
         [0072]      FIG. 3A  shows a side view of a preferred raised tab embodiment having a raised surface  33  and a blister  31  centered on raised surface  33 . A collapsible area  35  surrounds blister  31  and allows the raised tab to collapse uniformly when depressed by a user.  FIG. 3A  shows the raised tab in its non-depressed configuration while  FIG. 4  illustrates the collapsed tab  40 . When the tab is collapsed, the tab changes color. The change in color is preferably due to the transparent tab  30  becoming opaque when the tab is depressed. When in the depressed configuration, the tab is both visibly and tactilely different from the non-depressed configuration, thus serving as a double cue that a dosage has been taken and duly recorded.  
         [0073]      FIG. 3B  shows a side view of an embodiment having a single dimpled blister prior to a user pressing it to record the use of medication. The clear blister  30  contains a rounded top surface  32  and two concentric depression rings  34  which form the dimple  35 . The dimple  35  can be considered a collapsible area that enables the blister to collapse uniformly and be clearly distinguished from an inadvertent crushing of a blister due to, as for example, pressure at one edge of a blister. An adhesive layer  38  comprises the remainder of the device. The device could also contain a backing sheet  36 , but this is not necessary in all embodiments. In  FIG. 4 , the dimpled blister  40  has been depressed so that the rounded surface and the concentric depression rings making up the dimple are no longer visible. The top surface  42  is now inverted and flattened leaving a tactilely different surface for the user to feel. Furthermore the once clear blister is now opaque providing a visual signal along with the tactile signal. The adhesive layer  46  and optional backing layer  44  remain unchanged from its original configuration.  
         [0074]      FIG. 5  shows an alternate embodiment of the dimpled blister  50  wherein an additional concentric depression ring  58  is added to the existing pair of concentric depression rings  54  and  56  to make up the dimple. The rounded top surface  52  of the dimpled blister has not been depressed.  
         [0075]      FIG. 5   a  shows a further alternate embodiment of the dimpled blister  50   a  wherein an additional concentric depression ring  58   a  is added to the existing pair of concentric depression rings  54   a  and  56   a  to make up the dimple. In this embodiment, the top surface  52   a  of the dimpled blister is flat and in combination with the circular depression rings provides for the blister, after depression to be demarked by collapsed rings and a clear, flat, central region. The distortion of the depression rings turns the plastic from clear to opaque, as well known in the art.  FIG. 5   b  shows a top view of the collapsed dimpled blister in  FIG. 5   a . The concentric depression rings  54   a ,  56   a ,  58   a  have been depressed and the top surface  52   a  is flattened. The area between the rings designated  55 ,  57  has changed from a transparent appearance to an opaque one, providing the user with a visual signal that the medication has been taken for that time period.  
         [0076]      FIG. 6  illustrates a bottle system, or other form of medicine container, indicated generally as  60 , with a medication management label  62  wrapped around the container  64 . For simplicity, the raised tabs are not shown in this figure. It should be noted that the term “medicine”, as used herein is intended to be a generic term inclusive of prescription and non-prescription medications, and additionally, inclusive of herbal remedies, vitamins and other medications. The system of the present invention should be understood as being useful when used with a regimen of any medicine or agent that maintains health or promotes recovery from injury or ailment.  
         [0077]      FIG. 7  shows the medication management overlay  70  being separated from the underlying prescription label  72 . To enable the separation of the medication label overlay  70  from the underlying prescription label  72 , preferably, the overlay  70  is secured to the prescription label  72  by a pressure sensitive, releasable adhesive, as is well known in the adhesive art. Alternatively, the overlay can be releasable secured to the container  74  by a well-known hook and loop system, preferably applied at two opposite peripheral edges of the overlay.  
         [0078]      FIG. 7B  shows the preferred medication management label  71  having one end  71   a  attached to prescription label  73  of container  75 . The label  71  could also be attached directly to container  75 . Label  71  is preferably attached by an adhesive, which can be pressure sensitive and releasable. Alternatively, label  71  can be attached using a hook and loop system. In this attachment configuration the remainder of label  71  containing raised tabs  77  hangs freely from the container. As noted above, this free-hanging configuration serves as a flag drawing the attention of the patient to the package, thereby helping to remind the patient to take the medication. The flag labels are preferably manufactured in bright, eye-catching colors. These high visual-impact colors are well known in the art.  
         [0079]      FIG. 8  shows a medication management label and prescription label combination  80 , which contains typical prescription medication data. For example, patient name and address, pharmacy name and address, prescription number, dosage regimen, number of refills remaining, and refill expiration date can be printed on the label system  80 . The management system data can be noted in the label region identified as  82 . In the label system of  FIG. 9 , the medication management data is shown at an alternate position  92  on the label  90 .  
         [0080]      FIG. 10  shows a label overlay  100  which is illustrated as providing number of doses per day and the days of the week, for a two week or less prescription. The example of  FIG. 10  shows a Monday through Sunday sequence and designates the doses, as one, two and three.  
         [0081]      FIG. 12  shows the label overlay  120 , which is similar to that of label overlay  100  of  FIG. 10 , applied over a prescription label  122 . In this case the label overlay  120  uses a time of day indicator for a three a day, two-week regimen of medication. The use of a transparent film is preferred so as to make it possible to read prescription information through the overlay. Alternatively, or in addition thereto, the use of a releasable adhesive enables one to have full access to the prescription data. It should be evident from  FIG. 13 , that the overlay  130  can be transparent or translucent, and can cover all or part of the underlying label  132 . The use of a semi-opaque or translucent film provides the advantage of rendering the markings on the regimen label  132  more readily readable. Advantageously, the pressure-sensitive releasable adhesive is used with transparent overlays, as well as with opaque overlays. The adhesive can enhance the visibility of the writing or marking on the overlay  130 , while not totally concealing the information on the prescription label  132 .  
         [0082]      FIG. 11  illustrates a system similar to that of  FIG. 12 , except that the overlay  110  is applied to the extreme left hand end of the prescription label  112 , and is vertically oriented. It should be noted that the time of day notations on the overlays of FIGS.  11  and  12 , for example, could be applied by hand, or preferably, automatically by the pharmacy computer. The printing of the overlay information can be coordinated with the entry of prescription information, and thus a single entry of information would provide the data for the pharmacy data bank, the pharmacy&#39;s label and the overlay. Alternatively, the dosage can be indicated as being dose one, two and three, as illustrated in  FIG. 10 . Obviously, this would be coordinated with the actual number of doses per day, which is dictated by the dosage regimen.  
         [0083]      FIGS. 14 through 21  show alternate embodiments of overlay label patterns.  FIG. 14  shows a one-week, four-dose label. The label can also be used to record compliance by the user under a four-week, single daily dose regimen.  
         [0084]      FIGS. 15, 16  and  17  show three, two, and single dose regimen patterns, and similarly, can be used with single dose, multiple week regimen recordation.  
         [0085]      FIG. 18  shows a label having a pattern, which is conveniently used to record compliance with a single dose, one-month regimen.  FIG. 19  shows a label having a pattern, which is conveniently used to record compliance with a two dose, one-month regimen.  
         [0086]      FIGS. 20 and 21  show labels with three and four dose recordation patterns respectively. Alternatively, the pattern can be used for three week and four week, single dose regimens. That is, the columns of raised tabs can represent a series of weeks or doses per day.  
         [0087]      FIGS. 14, 15 ,  16  and  17  are further noted to show a Sunday through Saturday sequence and respectively show four, three, two and a single column of raised tabs corresponding to medications requiring, 4, 3, 2 or 1 dose per day, respectively. By way of contrast,  FIGS. 20 and 21  show label patterns in which the daily sequence starts with a Tuesday and a Friday respectively.  
         [0088]      FIG. 22  shows a modification of the label, in which the label is manufactured in a roll allowing the user to remove one label overlay at a time from a larger stock. This reduces the packaging required for multiple label overlays of the same configuration.  
         [0089]      FIG. 23  shows a label  230 , corresponding in design to the label  110  of  FIG. 11 . The label  230  is shown applied to a rectangular container  232 . The container can directly house the medicament, or can be a shipping container for a medicament container.  
         [0090]      FIG. 24  shows a regimen label  240  applied to a rectangular container  242 . The container  242  can directly house the medicament, or can be a shipping container for a medicament container.  
         [0091]      FIG. 25  shows a label  250 , corresponding in design to the label  110  of  FIG. 11 . The label  250  is shown applied to a rectangular bottle  252 , of the type that is used with liquids, or alternatively, of the type which can be used with pills, caplets, capsules, and the like.  
         [0092]     The combined prescription label/overlay medication regimen label can be printed at the pharmacy and thus customized to the particular requirements of a patient. The week can be started with any day of the week, depending on the day in which the prescription is being dispensed.  
         [0093]      FIG. 26  shows a variation of the containers of  FIGS. 6 and 7 , in which the overlay label  262  is dimensioned such that it can be applied to a region of the container  260 , which is not covered by a prescription or similar label  264 . It is noted that while reference is made to prescription labels, and the system of the present invention is uniquely suited for use with such labels, the system of the present invention is also applicable to non-prescription labels. As shown in  FIG. 26 , the overlay label  262  is positioned essentially between the two ends of the underlying prescription label  264 . In this manner, the overlay label  262  does not cover information displayed on the underlying label  264 . An opaque or semi-opaque label can be used in this instance, since it is not necessary to see through the overlay label  262 .  
         [0094]     In  FIG. 27  the use of the dimpled blister in a blister card as a means for dispensing medication, vitamins or other supplements in pill or tablet form is shown in a cutaway side view. The dimpled blister  270  surrounds the pill or tablet  272  and an underlying backing  274  is placed such that the pill  272  can be pushed through the blister card  276  with a minimal force. Various types of backings  274  to achieve this desired function are well known in the art. The dimpled blister  270  then flattens as described herein and changes from transparent to opaque providing the tactile and visual signals that are useful for maintaining the medication regimen. It should be noted that presence or absence of the pill  272  provides one level of visual signaling that medication has been taken but that the transparent to opaque change in the dimpled blister provides an additional level of visual signal.  
         [0095]      FIGS. 28 through 30  demonstrate a variety of the different styles of dimpled blisters that can be created by using an injection mold, vacuum forming or the like. The specific method of manufacture is not narrowly critical. Typically, with thin sheet materials, vacuum forming is a convenient manufacturing technique.  FIG. 28   a  shows one embodiment of an injection-molded design for the dimpled blister  280 . Two small rings of plastic  282 ,  284  that are thinner than the remaining plastic in the blister  280  provide the mechanism for collapse. Once the blister is depressed, the rings of plastic  282 ,  284  collapse in the manner shown in  FIG. 28   b , providing a more uniform collapse. This design reduces the likelihood of an uneven shape that could be misread tactilely by the user.  FIG. 28   c  shows a top view of the collapsed blister described in  FIG. 28   b.    
         [0096]      FIG. 29   a  shows a second embodiment of an injection-molded design for the dimpled blister. In this embodiment, two larger rings of plastic  292 ,  294  form an internal cut-out that is thinner than the remaining plastic in the blister and provide the mechanism for collapse. Once the blister is depressed, the rings of plastic  292 ,  294  collapse in the manner shown in  FIG. 29   b , providing a more uniform collapse. This design again reduces the likelihood of an uneven shape forming after the blister is depressed that could be misread tactilely by the user.  FIG. 29   c  shows a top view of the collapsed blister described in  FIG. 29   b.    
         [0097]      FIG. 30   a  shows a third embodiment of an injection-molded design for the dimpled blister  300 . In this embodiment, two larger rings of plastic  302 ,  304  form an external cut-out that is thinner than the remaining plastic in the blister and provide the mechanism for collapse. Once the blister is depressed, the rings of plastic  302 ,  304  collapse in a controlled manner as shown in  FIG. 30   b . This design again reduces the likelihood of an uneven shape forming after the blister is depressed that could be misread tactilely by the user.  FIG. 30   c  shows a top view of the collapsed blister described in  FIG. 30   b.    
         [0098]      FIG. 31  shows a non-uniformly collapsed blister  310  of the style shown in  FIG. 30 . When a package contained the blister cards is inadvertently damaged or pressure is accidentally applied to the blister on a side, the blister will collapse in the fashions shown, providing a different visual and tactile cue for the user. The user will then be able to distinguish a properly collapsed blister from one that is inadvertently damaged. This adds a layer of confidence to the medication tracking system so that the user can be assured of a proper medication regimen.  
         [0099]      FIG. 32  shows a fourth embodiment of an injection-molded design for the dimpled blister  320 . In this embodiment, two larger rings of plastic  322 ,  324  form an internal cut-out that is thinner than the remaining plastic in the blister and that is separated from the top of the blister. These rings provide the mechanism for collapse. Once the blister is depressed, the rings of plastic  322 ,  324  collapse in a controlled manner as shown in  FIG. 33 . As in the previous embodiments, this design reduces the likelihood of an uneven shape forming after the blister is depressed that could be misread tactilely by the user.  
         [0100]      FIG. 34  shows the blister of  FIG. 32  as used in combination to hold medication and as a medication tracker. The blister card  340  contains the medication  342  between the blister  344  and the backing card  346  or materials well known in the art. When the blister  344  is depressed, the medication  342  pushes through the backing card  346 , tearing open the backing card  346  and releasing the medication  342  as shown in  FIG. 35 . In  FIG. 35 , the medication  352  has been pushed through the blister card  350  by depressing the blister  354 . The backing  356  has tears upon depression of the blister  354  to permit the medication  352  to pass through. The blister  354  flattens out and changes from transparent to opaque providing tactile and visual cues that the medication has been taken.  
         [0101]     Another embodiment of a medication management device comprises a label with punch-out plugs, as shown in  FIG. 36 , instead of raised tabs. These punch-out plugs  361  are arranged in rows on label  360  just as the raised tabs described previously herein. Plugs  361  are simply perforated areas that can be easily removed from the label, thereby leaving holes  362  in the label where the plugs were once attached. Each plug  361  is removed by pushing on the plug using either one&#39;s finger or an item such as a pencil.  
         [0102]     Thus far, the invention has been shown and described as being used on medication bottles and pill packages. However, the label can be used on other items for monitoring dosages such as I.V. reservoirs shown in  FIG. 37 . The tabs on the label can be manufactured to correspond to I.V. dosage regimens. With this embodiment the label becomes a tool for health care providers to record treatments that is a double check of the information maintained in the patient&#39;s chart.  
         [0103]     The preceding examples are provided for descriptive purposes solely and are not meant to limit the embodiments of the invention. Other configurations of the medication record and dispensing system will become apparent to those of ordinary skill in the art.  
         [0104]     All documents, patents, journal articles and other materials cited in the present application are hereby incorporated by reference.  
         [0105]     Although the present invention has been fully described in conjunction with several embodiments thereof with reference to the accompanying drawings, it is to be understood that various changes and modifications may be apparent to those skilled in the art. Such changes and modifications are to be understood as included within the scope of the present invention as defined by the appended claims, unless they depart therefrom.