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Y X X 2 5 X

Y X X 2 5 X

In MEDICATION column include drug product name strength of drug date prescribed dosage route how often medication is to be taken any special instructions *Medication authorization form must be used as either a two-sided document or attached first and second page. Medication is appropriately labeled.

Medication Administration Record MAR RCEB

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Y X X 2 5 XControlled substance administration logs are recommended to document appropriate use and prevent diversion of medications with a high potential for abuse. Medication Administration Record MAR MO YR Facility Name Medication Hour Put initials in appropriate box when medication is given B Circle

Instructions. A. Write initials in appropriate box at the time medication is given. B. Circle initials when medication is refused. Y x 2 6x 8 Ayuda Por Favor Identifica El Rect ngulo Cuya rea Es Igual A X2 5x 6

Medication Administration Record MAR

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NOTE This form is intended to be used by HWC staff for prescribed non controlled medications and prescribed controlled substances File this in the SHR monthly Y x

Edit your medication administration record template form online Type text complete fillable fields insert images highlight or blackout data for discretion Y X2 3x Y x 1 x 1 1 5X 2 5X 3 5X jpg