- My Medicine Record. Food and Drug Administration. Be an Active Member of Your Health Care Team. FORM FDA 3664 (3/11). Save 'My Medicine Record' on your personal computer (PC).
- COMMENTS – REASON MEDICATION NOT GIVEN. DATE/TIME MEDICATION REASON NOT GIVEN INITIAL Name: _____ Record medication administration notes below. For medication not administered, use the codes in the box at the left, including appropriate dates, comments, and explanations.
Medication Administration Record for PRN'S SDS 0812B Page 1 of 2 (01/05) Resident: Physician: Date Hour Medication Reason Results Hour. Instructions A. Write initials in appropriate box at the time medication is given. Circle initials when medication is refused. State reason for refusal in the narrative. State reasons PRN is given.
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