Scribd
Upload
1K views2 pages

Med Sign-Off Sheet

This document is a medication administration sign-off sheet for a seniors and people with disabilities facility. It requires two staff signatures from each day, swing, and night shift to verify that all scheduled medications, PRN medications, treatments, and narcotics have been dispensed correctly according to procedures. Staff must sign with the time they are checking off each day on the sheet.

Uploaded by

Sheila Tolentino-Belanio
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
1K views2 pages

Med Sign-Off Sheet

This document is a medication administration sign-off sheet for a seniors and people with disabilities facility. It requires two staff signatures from each day, swing, and night shift to verify that all scheduled medications, PRN medications, treatments, and narcotics have been dispensed correctly according to procedures. Staff must sign with the time they are checking off each day on the sheet.

Uploaded by

Sheila Tolentino-Belanio
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Print

Medication Administration Accountability Sign-Off Sheet


Seniors and People with Disabilities State Operated Community Program

House: Error Swing shift signatures (2) Y/N

Month: Error Night shift signatures (2) Y/N Error Y/N

Two (2) staff from each shift must sign off below, signifying that all scheduled meds, PRN, treatments and narcotic(s) have been checked, dispersed and documented per medication administration procedures. OAR 309-049-0075 (3)(5)(6)(8). Day 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th

Day shift signatures (2)

Check time

Check time

Check time

Policy #4.012 Attachment B (Mandatory)

Page 1 of 2

DHS 4663 (9/09)

Two (2) staff from each shift must sign off below, signifying that all scheduled meds, PRN, treatments and narcotic(s) have been checked, dispersed and documented per medication administration procedures. OAR 309-049-0075 (3)(5)(6)(8).

Day 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st

Day shift signatures (2)

Check time

Error Swing shift signatures (2) Y/N

Check time

Error Night shift signatures (2) Y/N

Check time

Error Y/N

Policy #4.012 Attachment B (Mandatory)

Page 2 of 2

DHS 4663 (9/09)

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy