Many patients, especially elderly, very often don't inform family physicians about drugs prescribed by other specialist and use a number of preparations to self-medicate. These actions may supply negative consequences in recovery process and can be significantly reduced through the implementation of a well-run pharmaceutical care (PC) in the community pharmacy. Therefore, it is necessary to design proper PC documentation, which allows for comprehensive gathering information needed to carry out the analysis of relevant factors impacting on the prescribed pharmacotherapy effectiveness. The aim of this study was to develop the proper documentation to conduct PC in community pharmacy and verification of its correctness in the group of elderly patients, who is receiving treatment from family physician and additionally at least two specialized doctors. Also an assessment of PC implementation validity as a specialized service was presented. A study was carried out from January 2014 to June 2015. The research covered 54 elderly (41.0% men and 59.0% women) in Jarocin (Poland). Pharmacist was filling in the designed PC form, which subsequently was analyzed mainly for pharmacotherapy problems. The study indicated that 48.1% of patients were counselled by at least 3 specialists; 66.7% of patients were treated by cardiologist and 55.6% by the ophthalmologist; 75.9% of participants had hypertension. 42.6% of the patients used 10 or more pharmaceuticals and 24.1% took 8 or 9 drugs. Moreover, 20.4% of participants used drugs irregularly and 7.4% of them took too low doses of medications. Additionally, during the pharmacotherapy analysis, very significant and significant drug-drug interactions were noticed (1.1% and 18.4%, respectively). Very significant drug-food interactions occurred in 1.4% cases and significant in 3.3% cases. Total number of detected interactions were 553. The substantial analysis of participants' data allowed for 48 patients selection for pharmaceutical counselling. Six patients were involved into the group where PC process was reasonable. These patients often used 10 or more drugs (p = 0.0026), discontinued using medication without doctor consulting (p = 0.0201) and did not follow up the prescribed pharmacotherapy (p = 0.0351). This study provides new data about implementation of PC in Poland. The designed PC documentation may be helpful for proper analysis of the patient's pharmacotherapy to avoid drug problems and to improve elderly patients' quality of life. This project may contribute to PC implementation in Polish community pharmacy.