These forms are designed to prompt the recording and procedure to follow when medications are refused or withheld:
- Resident name
- Date and time of missed dose
- Reason for medication(s) missed
- Date and time if medication(s) administered later
- Doctor notified or not notified
- Time doctor notified
- Directive from doctor if appropriate
- Family notified or not notified
- Time family notified
- Label format - Detach and adhere to manual progress notes.
- Paper format - Input medium for computer generated progress notes - Sign each entry when data entry is made.