OLD
ALLERGIES & ADVERSE REACTIONS (ADR)
( ) No Known . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ./. . . /. . . . Drug Alert Signature Date ( ) Drug Alert PERSONAL PARTICULARS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /. . . ./. . . . Signature Date
DR UG AL E R T L AB E L
Client’s Surname Given Name:
Client Preferred Name:
Date of Birth:
Client No.
ATTAC H AL E R T L AB E L HE R E AND WHE R E INDIC ATE D INS IDE C HAR T Enter Details:
7 RIGHTS’ OF MEDICATION ASSISTANCE
2. 3. 4. 5. 6.
Right Person Check Right Drug or medication Right Dose these Right Time / Date / Day 5 rights Right Route (which way is medication 3 times given, orally, topically etc) 7. Write it Down - Staff sign when medication has been administered. REFER TO CARE PLAN ROUTINE
DOSE OMITTED CODES
Medications not able to be given should be recorded in Client’s Notes
Crush
Observe Swallowing Encouragement Needed
Absent
A
Not Required
N/R
Whole
Adjusted Administration
A/T
Omitted
O
Thickened Fluids
Fasting
F
Refused - Notify Dr
R
Hospital
H
Self Administering
S
On Leave Withheld - Enter reason in Clinical Record No Stock
L
Vomitting Withheld - Pending Results Unusable (eg. dropped)
V
W
N
Peg Other
W/R
U
VACCINATIONS
S cheduled C hildhood Vaccine UTD
Yes
No
Influenza Vac c ine
- Date L as t G iven:
/
/
P neumococcal Vaccine
- Date L as t G iven:
/
/
Tetanus Vac c ine
- Date L as t G iven:
/
/
Hep A/ B Vac c ine
- Date L as t G iven:
/
/
- Date L as t G iven:
/
/
- Date L as t G iven:
/
/
- Date L as t G iven:
/
/
PRESCRIBER PARTICULARS
Phone No. ENTITLEMENT NUMBERS
PHARMACY PARTICULARS
Pharmaceutical Benefits Entitlement Number
/ / VALID TO
02/13 Phone No.
Medicare Number
/ / VALID TO
© COPYRIGHT COMPACT BUSINESS SYSTEMS PTY LTD 2010
Community Medication Record
1. Right Method - Obtain details from Care Plan eg. break in half, crush, put into yogurt etc.