BCHS-3267 at a glance
What it is: This is the A.F.C. Resident Medication Record of the Michigan Department of Licensing and Regulatory Affairs, Bureau of Community and Health Systems.
Who signs: Each Person Signing Initials enters a Signature and Initials.
A filled-in BCHS-3267 example: one morning medication for March 2026
How to fill out BCHS-3267, box by box
Resident Name, Month and Year
Enter the Resident Name, the Month and the Year.
Medication Name And Instructions For Use
Under Medication Name And Instructions For Use, write each medication and its instructions, and enter its Time Of Day.
Medication Name (Single Dose Only)
Under Medication Name (Single Dose Only), write each single dose medication and enter its Time of Day.
Signature and Initials of Each Person Signing Initials Above
Each Person Signing Initials enters a Signature and Initials.
Common questions about BCHS-3267
Is there a penalty?
Completion is mandatory for all AFC types; the penalty is for violation of Rule R 400.675(4).
Sources
[1] BCHS-3267 (Rev. 11-25), A.F.C. Resident Medication Record, Michigan Department of Licensing and Regulatory Affairs (the Official source link on this page).