Are you having difficulty managing your medication? The American Pharmacists Association (APA) has developed the “Medication Form APD” as a means to help individuals keep track of their prescriptions and medications. This form can don't just be used to document current medication usage, but also provide an individual with important information such as when each dose should take place and check for any potential drug interactions. Not only is this form helpful in tracking daily use, but it ensures that patients receive prompt care if necessary by providing their healthcare provider with comprehensive details on their medication regimen. By making use of this simple printable PDF tool, individuals can obtain better control over their health both now and in the future.
| Question | Answer |
|---|---|
| Form Name | Medication Form Apd |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | medication apd, 65g7, form apd given, apd 65g 7 medication administration |
|
Medication Administration Record (MAR) |
|
Name:_____________________________________ Month:______________, Year: 20___ |
|
Allergies: _________________________________________________________________ |
|
|
Medication |
Time 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Drug Name, Dosage, Route |
|
Prescribed By:
Drug Name, Dosage, Route
Prescribed By:
Drug Name, Dosage, Route
Prescribed By:
Drug Name, Dosage, Route
Prescribed By:
Drug Name, Dosage, Route
Prescribed By:
Drug Name, Dosage, Route
Prescribed By:
NOTES:
Signature
Initial
Signature
Initial
APD Form
REASON MEDICATION NOT ADMINISTERED
1 = Home
2 = Work/ADT
3 = ER/Hospital
4 = Refused
5 = Medication not available – explain 6 = Held by MD – explain
7 = Other – explain
Time, date, and initial each explanation.
Sign and initial at the bottom of the form.
Name: ____________________________________________________________________________
Record medication administration notes below. For medication not administered, use the codes in the box |
|||
|
COMMENTS – REASON MEDICATION NOT GIVEN |
|
|
at the left, including appropriate dates, comments, and explanations. |
INITIAL |
||
DATE/TIME |
MEDICATION |
REASON NOT GIVEN |
|
SIGNATURE
INITIALS SIGNATURE
INITIALS SIGNATURE
INITIALS
APD Form