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Medication (Record Keeping) Templates

A set of templates for use in adult care settings.

All templates are in Word document format, they include a header and footer for care settings to insert their own name. The templates comply with standards required by care settings.

Word Documents – all templates for use:

  • Administration of Medication Consent Form (1 page)
  • Contact List for Suppliers and Prescribers of Medication (4 pages, numbered)
  • Controlled Drugs Audit Record (5 pages, numbered)
  • Medication Administration Record (MAR Chart) Record (3 pages, numbered)
  • Medication Dosage Alteration Request (1 page)
  • Medication Incident Form (3 pages, numbered)
  • Medication Omissions Record and Alterations to Normal Routine (5 pages, numbered)
  • Monthly Medication Audit Record (12 pages, numbered)
  • Non Prescribed/Home Remedies Check List (2 pages, first page shows examples which can be deleted, second page table is blank, not numbered)
  • Record of Medicines Received (1 page, no page number in footer so that it can be re-printed off if more pages required, page number to be inserted manually at the top of the form)
  • Record of Receipt of Medications and Prescriptions (1 page, no page number in footer so that it can be re-printed off if more pages required, page number to be inserted manually at the top of the form)
  • Risk Assessment for Self-Administration of Medicines (4 pages, numbered)
  • Self-Administration Client Confirmation Record (2 pages, numbered)
  • Self-Administration Review Form (1 page, no page number in footer so that it can be re-printed off if more pages required, page number to be inserted manually at the top of the form)
  • Staff Trained to Administer Medication Record (1 page, no page number in footer so that it can be re-printed off if more pages required, page number to be inserted manually at the top of the form)
  • Unidentified Medicines List (1 page, no page number in footer so that it can be re-printed off if more pages required, page number to be inserted manually at the top of the form)

Available on CD or via Download

Medication - Record Keeping Templates
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