Assisted Living Facility Name:
Facility Address: Unit # Zip:
Phone:  Email:

Resident Name:
Date of Birth:
Date of Admission:
Physician Name:
Emergency Contact Name:
Phone:

1. Purpose of the MAR

The Medication Administration Record ("MAR") is used to document the administration of medications to residents in the Assisted Living Facility. This record ensures proper tracking, accuracy, and compliance with healthcare regulations.

2. Medication List

Medications prescribed to the resident, including dosage, route, frequency, prescribing physician, start date, end date, and any special instructions, must be recorded in the MAR.

3. Medication Administration Schedule

The facility staff will document the date, time, medication name, dosage, route, and the name of the person administering the medication, along with any notes regarding administration.

4. PRN (As Needed) Medications

PRN medications will be documented with the medication name, dosage, route, indication for use, date/time given, administrator's name, and any relevant notes.

5. Medication Changes and Discontinuation

Any changes in medication, including dosage adjustments, new prescriptions, or discontinuation, must be documented, along with physician authorization and relevant notes.

6. Resident Allergies and Special Considerations

  • Known Allergies:

  • Dietary Restrictions:

  • Other Considerations:

7. Staff Signatures & Initials

Each staff member responsible for medication administration must sign and provide their initials as part of the MAR record.

8. Medication Administration Policies

  • Medications will only be administered as prescribed by a licensed physician.

  • Staff must verify the Five Rights of Medication Administration before administering any medication:

    1. Right Resident

    2. Right Medication

    3. Right Dose

    4. Right Route

    5. Right Time

  • Any medication errors must be reported immediately to the supervising nurse or administrator.

  • PRN medications will only be administered based on the physician's instructions and as documented.

  • If a medication is refused, delayed, or missed, it must be documented in the notes section along with the reason.

9. Emergency Procedures

  • In case of an adverse reaction or medication error, staff must:

    1. Contact the resident's physician immediately.

    2. Document the incident in the MAR.

    3. Notify the resident’s emergency contact.

    4. Complete an incident report as required by facility policy.

10. Acknowledgment and Verification

By signing below, the Resident, Legal Representative, and Facility Representative acknowledge that they have reviewed and understand the Medication Administration Record and policies.

Resident Name:
Resident Signature:

*


Date:

Legal Representative Name (if applicable):
Legal Representative Signature:

*


Date:

Facility Representative Name:
Facility Representative Signature:

*


Date:

 

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