LIC 662 Form PDF Details

In the realm of health and human services, meticulous record-keeping plays a critical role in ensuring both compliance with regulations and the well-being of individuals under care. This is where the Lic 622 form comes into prominence, serving as an indispensable tool within the regulatory framework established by the State of California's Department of Social Services Community Care Licensing Division. Designed to standardize the tracking of centrally stored medication and its eventual destruction, the form bridges the gap between regulatory requirements and practical application in care facilities. Its dual-component structure obliges facilities to document crucial information regarding medication storage and disposal, encompassing details from the names and strengths of medications to the dates of expiration, filling, and administration. Further emphasizing its significance, the form stipulates that medication records be maintained for a specified duration, varying by facility type, to ensure accountability and facilitate audits. With sections dedicated to both the initial custody of medication and its appropriate destruction, the Lic 622 form embodies a holistic approach to medication management within the sensitive environment of healthcare provision, highlighting the interface between policy, facility administration, and patient care.

QuestionAnswer
Form Name LIC 662 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names lic 622 form, lic 622 centrally stored, centrally stored medication, centrally stored medication record

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

CENTRALLY STORED MEDICATION AND DESTRUCTION RECORD

I. CENTRALLY STORED MEDICATION

INSTRUCTIONS: Centrally stored medications shall be kept in a safe and locked place that is not accessible to any person(s) except authorized individuals. Medication records on each client/resident shall be maintained for at least one year.

FACILITY NAME

FACILITY NUMBER

NAME

(LAST

FIRST

MIDDLE)

ADMISSION DATE

ATTENDING PHYSICIAN

ADMINISTRATOR

MEDICATION NAME

STRENGTH/

QUANTITY

INSTRUCTIONS

CONTROL/CUSTODY

EXPIRATION

DATE

DATE

FILLED

DATE

STARTED

PRESCRIBING

PHYSICIAN

PRESCRIPTION

NUMBER

NO. OF

REFILLS

NAME OF

PHARMACY

LIC 622 (3/99) (CONFIDENTIAL)

MEDICATION NAME

STRENGTH/

QUANTITY

INSTRUCTIONS

CONTROL/CUSTODY

EXPIRATION

DATE

DATE

FILLED

DATE

STARTED

PRESCRIBING

PHYSICIAN

PRESCRIPTION NO. OF

NUMBER REFILLS

NAME OF

PHARMACY

II. MEDICATION DESTRUCTION RECORD

INSTRUCTIONS: Prescription drugs not taken with the client/resident upon termination of services or otherwise disposed of shall be destroyed in the facility by the Administrator or

Designated

Representative and witnessed by one other adult who is not a client/resident. All facilities except Residential Care Facilities for the Elderly (RCFEs) shall

retain destruction

records for at least one year. RCFEs shall retain records for at least three years.

 

 

MEDICATION NAME

STRENGTH/

QUANTITY

DATE FILLED

PRESCRIPTION DISPOSAL

NUMBERDATE

NAME OF PHARMACY

SIGNATURE OF ADMINISTRATOR OR

DESIGNATED REPRESENTATIVE

SIGNATURE OF WITNESS

ADULT NON-CLIENT

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As for the blanks of this particular document, here's what you should consider:

1. When completing the lic 622 destruction record, make sure to incorporate all of the essential blank fields within the associated area. It will help to facilitate the work, enabling your details to be handled fast and accurately.

Find out how to complete centrally stored medication record portion 1

2. Immediately after this part is filled out, proceed to type in the applicable details in these: LIC CONFIDENTIAL.

Stage number 2 of completing centrally stored medication record

People frequently get some points incorrect while filling in LIC CONFIDENTIAL in this area. You need to review what you enter right here.

3. This stage is normally straightforward - fill out all of the empty fields in MEDICATION NAME, QUANTITY, CONTROLCUSTODY, DATE, FILLED, STARTED, PHYSICIAN, NUMBER, REFILLS, and PHARMACY to complete this process.

Filling in section 3 of centrally stored medication record

4. The next paragraph needs your attention in the following parts: MEDICATION NAME, QUANTITY, DATE FILLED, NUMBER, DATE, NAME OF PHARMACY, SIGNATURE OF ADMINISTRATOR OR, SIGNATURE OF WITNESS, DESIGNATED REPRESENTATIVE, and ADULT NONCLIENT. Just remember to enter all of the needed information to go forward.

Completing part 4 in centrally stored medication record

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