This document is subject to confidentiality requirements and should be handled accordingly.
Medications: all medications involved in error must be listed; use additional pages if needed.
Times: describe all errors involving times in description of incident.
Error type: please select the option that best fits the type of error.
Starred errors: error type starred above must be reported to healthcare practitioner.
Who completes: one section is to be completed by Supervisory Personnel (APD Provider) and one by Department (APD/MCM).
| Question | Answer |
|---|---|
| Form Name | APD Form 65G-7.006 A |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 9 min |
| Edition | April 2019 |
| Issuing agency | Agency for Persons with Disabilities |
| Rule | Rule 65G-7.006, F.A.C. |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | 65G-7.006 A, 65G-7.006A, APD Form 65G-7.006 A, APD Medication Error Report |
| Official source | APD Form 65G-7.006 A (Rev April 2019), Agency for Persons with Disabilities |
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