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  • Med Sign-Off Sheet

    Enviado por

    Sheila Tolentino-Belanio
    402 visualizações2 páginas
    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.

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    sign off accountability

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    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.

    Direitos autorais:

    Attribution Non-Commercial (BY-NC)
    Baixe no formato PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    402 visualizações2 páginas

    Med Sign-Off Sheet

    Enviado por

    Sheila Tolentino-Belanio
    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.

    Direitos autorais:

    Attribution Non-Commercial (BY-NC)
    Baixe no formato PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    de 2

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    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)

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