Medication Disposal Record Form MCAR 023-080-585 Unused, outdated, discontinued, recalled, or contaminated medications, including controlled substances, shall not be kept in the home and shall be disposed of according to federal ')h>-J*EgR=pIRX~%f"5J9rirf(peAeKlK>LEOQeK>Zc,g%f.3I=NM+n3:{c}~n]G.H[?r~/;+~.>-,|O`ws`"b")1HWJ3%Dy&HgH+%tD:?L%JtD:C"])HWJ3%JtDnDR")_Hz%_rmC!ba(fD#Jh~lh4Q{0zfTfDA3=Ho e3 endstream endobj 27 0 obj 501 endobj 28 0 obj << /Filter /FlateDecode /Length 27 0 R >> stream Version: 1.113 0000001239 00000 n 0000000693 00000 n 0000002037 00000 n 0000001444 00000 n {0W\93*-ajwB}2M1C:4\#{p3gzQ1.vg6~dA<4?A;@R^gi7@|O1yZyG$#l]L< R95~NBUWb8)'j 30230uq00`Xpi\'00``l``r;"7Iu%4of #C endstream endobj 45 0 obj 120 endobj 8 0 obj << /Type /Page /Parent 3 0 R /Resources 9 0 R /Contents [ 20 0 R 24 0 R 26 0 R 28 0 R 30 0 R 32 0 R 34 0 R 36 0 R ] /Rotate 90 /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] >> endobj 9 0 obj << /ProcSet [ /PDF /Text ] /Font << /TT2 14 0 R /TT4 12 0 R /TT6 16 0 R /TT8 17 0 R /TT10 22 0 R >> /ExtGState << /GS1 43 0 R >> /ColorSpace << /Cs6 18 0 R >> >> endobj 10 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 718 /Descent -211 /Flags 32 /FontBBox [ -628 -376 2034 1010 ] /FontName /OIIMNH+Arial,Bold /ItalicAngle 0 /StemV 144 /FontFile2 40 0 R >> endobj 11 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 34 /FontBBox [ -568 -307 2028 1007 ] /FontName /OIIMOJ+TimesNewRoman /ItalicAngle 0 /StemV 0 /FontFile2 37 0 R >> endobj 12 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 32 /Widths [ 250 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMMG+TimesNewRoman,Italic /FontDescriptor 15 0 R >> endobj 13 0 obj << /Type /FontDescriptor /Ascent 905 /CapHeight 0 /Descent -211 /Flags 96 /FontBBox [ -517 -325 1082 998 ] /FontName /OIIMME+Arial,Italic /ItalicAngle -15 /StemV 0 /FontFile2 38 0 R >> endobj 14 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 114 /Widths [ 278 0 0 556 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 556 0 0 0 0 0 0 0 0 0 0 0 0 611 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 833 0 556 0 0 333 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMME+Arial,Italic /FontDescriptor 13 0 R >> endobj 15 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 98 /FontBBox [ -498 -307 1120 1023 ] /FontName /OIIMMG+TimesNewRoman,Italic /ItalicAngle -15 /StemV 0 /FontFile2 42 0 R >> endobj 16 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 121 /Widths [ 278 0 0 0 0 0 0 0 333 333 0 0 0 0 0 278 556 556 0 0 0 0 556 0 0 556 333 0 0 0 0 0 0 722 0 722 722 667 611 0 0 278 0 0 0 833 722 778 667 0 722 0 611 0 0 0 0 0 0 0 0 0 0 0 0 556 611 556 611 556 0 611 0 278 0 556 278 889 611 611 611 0 389 556 333 611 0 0 0 556 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMNH+Arial,Bold /FontDescriptor 10 0 R >> endobj 17 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 32 /Widths [ 250 ] /Encoding /WinAnsiEncoding /BaseFont /OIIMOJ+TimesNewRoman /FontDescriptor 11 0 R >> endobj 18 0 obj [ /ICCBased 39 0 R ] endobj 19 0 obj 1065 endobj 20 0 obj << /Filter /FlateDecode /Length 19 0 R >> stream trailer Disclosure of Ownership and Control Interest Statement (06/19/2012) 9. !V]Bu b%KHU. Medication Administration - "You Are Your Brother's Keeper" Self-Directed Home Care for: State Programs. Google Translate is an online service for which the user pays nothing to obtain a purported language translation. Call NJPIES Call Center for medical information related to COVID. Date of Report . Published Wednesday, Nov. All over-the-counter medications being administered to the client must have a written physician's order documented in the client's record per Section 17a-210-6. <>/Metadata 553 0 R/ViewerPreferences 554 0 R>> fao.b*lIrj),l0%b for electronic AND hand-written completion. Medication Administration Record (MAR) Published User Guides Support RSS Feed. Application and Consent for Sterilization of Pets, Payment Voucher / Veterinarian Reimbursement, Animal Population Control Program Proxy Authorization, Rehabilitative Hospital and Special Hospital subject to a $10 Adjusted Admission Assessment, Asbestos Management Plan, Room/Functional Space Inspection, Request for Bacterial or Viral Culture or Parasite Identification, Application For Certificate of Approval To Operate a Youth Camp, Application For Certificate of Approval To Operate a Single Sport Youth Camp, Annual Accident Report Youth Camp Safety Act, Youth Camp Self-Inspection Report (for Youth Camp Operators), Youth Camp Safety Detailed Data Sheet (for Local Health Inspectors), Youth Camp Safety Detailed Data Sheet (for Youth Camp Operators), Certification for the Replacement of Main Drain Covers in Pool/Spa, Pediatric HIV Confidential Case Report Form, Typhoid And Paratyphoid Fever Surveillance Report, Cholera And Other Vibrio Illness Surveillance Report, Multisystem Inflammatory Syndrome Associated with COVID-19: Case Report Form, For Reporting Reportable Communicable Diseases, Patient Symptoms Line Listing (Respiratory Tract Infection), Patient Symptoms Line Listing (Gastrointestinal Infection). Word version contains instructions. P D word/document.xml][oH~_i485(zVgV)T~.v ;i* :uN\~4 K]g~=]zg%nH#r[?|So6%QjAQ2Eo0&d&c4C:9SmbF=$=IOV7-FcA[cnPt8uYj4a.n{CaP%X-J%o 4J&A|+NT74Tc^Uhp9bYaEi(je$EUoSdQVM8b8NlW[V2fy%*(IzOOe(cgdLGtk>|v )A~?-bhfO\aKc%v=(n>;K($iMS:mZOMQcE?~vto#4?gJ+Nq".+-oMqRHD?^R%/&,qA3/zU=[]s;!^NSu`E`$#X0ay]qL/X:m8)v9P3p[qUw>6(gO/ DHt. |[ N [Content_Types].xml ( n0ED'(,g6@][D9NP'Q-57,{87[gQ9[b2UJk-VB;%Ad7OCHmc+QX8Fj@V$Vg\:`1;Fcv- ew)d$6O#W@7"VR ? Y*H|KBGByMurUA ~wqNB'ne}r?Fs`j2Ng }M-"4**QoIt'&I[G4@F yu HZ}g=:y!BxduKrtxp`+sz'StJ7'.>\VI?\gHsUO6o , PK ! You can use Facility Locator to locate your nearest .A veteran is entitled to an annual clothing allowance for each prosthetic or orthopedic appliance (including, but not limited to, a wheelchair) or medication used by the veteran if Clothing Allowance is a single, annual allowance paid out to the veteran, in the sum of $753. medication(s) for MAID. The forms are listed alphabetically by form number in PDF and Word template format. If OTC, in the original box with student's name The information on the container must match the written order. New Jersey DoH presents 'Requests for In-Home Vaccination'. endobj %%EOF 1 0 obj Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, [3] [4] [5] as well as paying for half of all U.S. births in 2019. DDD Day Program Manual 11/06 Forms: Form F5 STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES - DIVISION OF DEVELOPMENTAL DISABILITIES Medical Form for Adults Name: _____ Age: _____ DOB: _____ { } Male { } Female . 0 [6] Provisions for the utilization of a Medication Administration Record (MAR) for all medicinal drugs administered to patients of the facility. !WWE` & endstream endobj 25 0 obj 505 endobj 26 0 obj << /Filter /FlateDecode /Length 25 0 R >> stream Lt. PLEASE ISSUE PRESCRIPTIONS FOR MEDICATION, DIET, ADAPTIVE EQUIPMENT, PROCEDURES AND THERAPIES. A medication administration record to document any medications given as instructed in rule 65G-7.008, F.A.C. To receive Division Circulars, special alerts related to Division Circulars, and regulation updates by email, send a request to DDD-CO.LAPO@dhs.nj.gov and include your name, email address, and affiliaton (agency, individual, family, advocate, etc.) Mock Medication Administration Observation Checklist (Initial Only-Not Required for Recertification) Areas of Demonstration Mock Trial CommentsDate: Yes No 1. 0000009121 00000 n DDD Medicaid Providers - If your information is inaccurate, click the following link to download the. Individual Records 28. Medication Administration | Providers APD > Medication Administration Florida Administrative Code Rule Chapter 65G-7 APD Form 65G-7.008 - Medication Administration Record (MAR) PDF - MS Word APD Form 65G-7.002A - Authorization for Medication Administration PDF APD Form 65G-7.002B - Informed Consent for Medication Administration PDF . %PDF-1.4 % Division Circulars are documents issued by the Assistant Commissioner that set policy for the various agencies within the Division of Developmental Disabilities. Affirmative Action Survey (optional) 12. "Community Services" means a component of the Division of Developmental Disabilities which provides housing and supportive services to aid persons with developmental disabilities in establishing themselves in the . You may also contact Please select a role from drop-down to login. 75 0 obj <> endobj Title: iRecord 3.0 User Guide. Month and Year: CODE: 2. %%EOF New Jersey; New Mexico; New York; North Carolina . Financial 27. Disposing of Medications Demonstrates competency in agency policies and practices for proper medication d isposal. Duty Area 7: Demonstrate the Five Rights of Medication Administration 69-76 . 0000004088 00000 n Compensation 26. 0000001670 00000 n Medication Administration Medication Administration Medication administration training and certification developed by DODD authorizes caregivers to perform a variety of tasks for people with many different medical conditions. 2960 0 obj<> endobj Application to Amend a New Jersey Vital Record / Application for a Certified Copy of Amended Record (Updated February 7, 2019) pdf . Results 1 - 2 of 2. 0000008521 00000 n NEW! The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. N _rels/.rels ( JAa}7 Authorization for Automatic Payments & Deposits 13. 4Rym_0' individuals with developmental disabilities; however, these owner-occupied living arrangements are governed by N.J.A.C. Asbestos Training Course Proposal Checklist, Survey Report for Mobility Assistance Vehicles (Sample), Survey Report for Ambulance (Basic Life Support) (Sample), Survey Report for Ambulance (Advanced Life Support) (Non-Transport) (Sample), Survey Report for Ambulance (Advanced Life Support) (Transport) (Sample), Quarterly Report of Specialty Care Transport Units, Application for Accreditation - Emergency Medical Technician Education Program, Application for Certification as an Emergency Medical Technician-Basic Instructor, Emergency Medical Technician Training Fund Final Reimbursement Report, Emergency Medical Technician (EMT) Training Fund Certificate of Eligibility for EMT Education, EMT & Paramedic Clinician Reciprocity Application Verification of EMT & Paramedic Education and Licensure, New Jersey Medical Reserve Corps User Enrollment Request, Registration of Drug or Medical Device Manufacturing or Wholesale Drug or Medical Device Business, Bulk and Bottled Water Establishment Application, Initial Application for License to Operate a Refrigerated Warehouse and/or Locker Plant, Initial Application for License to Operate a Non-Alcoholic Beverage Manufacturing Plant, Application for Certificate of Free Sale (CFS), Renewal or Discontinuation Application to Operate a Wholesale Drug or Medical Device Business, Application for Permit to Handle Nitrous Oxide, Renewal Application to Operate a Refrigerated Warehouse-Locker Plant, Initial Application for License to Operate a Wholesale Food-Cosmetic Establishment, Retail Food Inspection Report (Local Health Departments), Risk-Based Inspection Report (Local Health Departments), Renewal Application to Operate a Non-Alcoholic Beverage and/or Bottling Plant, Renewal Application to Operate a Wholesale Food/Cosmetic Establishment, Renewal Application for Certification to Sell Bottled Water or Bulk Water, Application for Certification to Handle Oysters, Clams or Mussels, Individualized Family Service Plan (IFSP), Initial Uniform Application for Services to Individuals 21 and Under with Developmental Disabilities, Withdrawal of Dispute Resolution Request (formerly titled "Withdrawal of Complaint"), Family Cost Participation Application for Income Adjustment, Family Cost Participation Income Documentation, Family Cost Participation - Payment Options, Family Cost Participation Tables - SFY 2023 Hourly Co-Pay, Certificate of Free Sale Package (English) (including F-L3 and F-12 Forms), Certificate of Free Sale Package (Spanish) (including F-L4 and F-12 Forms), EMPLOYEE IDENTIFICATION (BUILDING/PARKING) MULTIFORM, Statement of Interest Earned from Advance Payments Deposited into an Interest Bearing Account, Grant Application Package - Construction Grant (FS-26), Report of Serious Preventable Adverse Event in a New Jersey Licensed Health Care Facility (for use on or after January 1, 2007) (formerly HCQO-19), Report of Serious Preventable Adverse Event in a New Jersey Licensed Health Care Facility - Root Cause Analysis (RCA) (for use on or after January 1, 2007) (formerly HCQO-20), Daily Patient Care Staffing: Inpatient Units, Daily Patient Care Staffing - Inpatient (Spanish), Daily Patient Care Staffing: Emergency Department, Daily Patient Care Staffing - Emergency Department (Spanish), Daily Patient Care Staffing: Post-Anesthesia Care Unit, Daily Patient Care Staffing - Post Anesthesia Care Unit (PACU) (Spanish), Daily Patient Care Staffing-Other Licensed Health Care Professionals: Hospital-Wide, Daily Patient Care Staffing - Other Licensed Health Care Professionals, Hospital Wide (Spanish), Open Heart Surgery Risk Stratification Project - Data Collection Form, Version 4.3, Financial Report for Licensed Ambulatory Care Facilities Subject to the Ambulatory Assessment, Surgical Practice Application for Registration, Renewal, Relocation, Transfer of Ownership, Specimens for Newborn Biochemical Screening, Order form for Initial Newborn Screening Request (IEM-1) Forms, Annual College Immunization Status Report, Standard School/Child Care Center Immunization Record, Retrospective Immunization Audit / Survey, Provisional Admittance Student Tracking Record, Confidential Perinatal Hepatitis-B Case and Contact Report, New Jersey Immunization Information System (NJIIS), Site Enrollment Request: Early Hearing Detection and Intervention Program, User Enrollment and Training Request: Early Hearing Detection and Intervention Program, NJIIS User Enrollment and Training Request, User Confidentiality Statement for Access to NJIIS/ User Confidentiality Agreement, Request for Change to NJIIS Immunization Record, Request for Copy of NJIIS Immunization Record, Request for Medical Exemption From Mandatory Immunization, Application to Continue Human Subjects Research, Application to Modify Human Subjects Research, Request for Microbiological Testing of Food Sample, Request for Testing of Suspected Pathogens of Public Health Significance and Chain of Custody, Application for the Addition of Long-Term Care Beds, Facility Reporting Incident Data and Analysis Yield (FRIDAY), Application for a Long-Term Care Facility License, Application for Registered Environmental Health Specialist Examination, Application for Health Officer Examination, Uniform Shared Services Agreement (Template) for Local Public Health Services, Red Book-Local Health Emergency Contact Directory, Report of Childhood Blood Lead Analysis by Independent Laboratory (for children 16 years of age and under), Notification form Long-Term Care Facility of Admission or Termination of a Medicaid Beneficiary, Application for a Milk Plant or a Bulk Milk Hauler (BTU) Permit, License to Manufacture Frozen Desserts Establishment Application, Renewal Application to Operate a Frozen Dessert Plant. 0000005319 00000 n The prescribed daily dose (PDD) is defined as the average dose prescribed according to a representative sample of prescriptions. o word/_rels/document.xml.rels ( MO0H*wu] iWk:mDTZ-RkOU|ud$).s>'CV 9Y#j%W%v9GJ@1?*>%mb%`0_Lj&"'vVxk!$' * > % mb % ` 0_Lj & '' 'vVxk! $ a purported language translation medications given as in. 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