Who needs the APD Form 65G7-00?
Clients of the Agency for Persons with Disabilities (APD) of the State of Florida need this form.
What is the APD Form 65G7-00 for?
The APD Form 65G7-00, or Medication Administration Record, is the chart maintained for each APD client that records medication information.
An up-to-date APD Form 65G7-00 must be maintained for each client that requires assistance with medication administration, except when the client is off-site. The provider of medication assistance must keep a record of the administration of medication or supervision of self-administered medication using the APD Form 65G7-00.
Is the APD Form 65G7-00 accompanied by other forms?
Apart from the APD Form 65G7-00, each client record must contain the following documentation available to the provider of medication assistance and for APD review upon request:
(a) For each medication, a list of adverse reactions, side effects, and drug interactions;
(b) A record of drug counts for each controlled medication;
(c) The client’s physician’s written determination that the client needs assistance with the medication administration; and
(d) The Informed Consent form that permits a provider of medication assistance to help with the administration of medication.
When is the APD Form 65G7-00 filled?
A validated medication assistance provider must comply with the following requirements: record the date, time, dosage, and name of each medication in the MAR immediately following administration and sign the entries.
What information should be provided?
The APD Form 65G7-00 includes the following information:
(a) Name of the client;
(b) Allergies to medication or food;
(c) The name of each medication prescribed for client;
(d) The strength of medication (i.e., 5mg/ tsp);
(e) For each medication, the prescribing health care practitioner;
(f) The date that the medication was ordered and any date of change of the medication;
(g) Prescribed dosage;
(h) Scheduled time of administration;
(i) Prescribed route of administration;
(j) If applicable, prescribed instructions for crushing, mixing or diluting of specific medications;
(k) The dates when each medication was administered;
(l) The initials and signature of the provider of medication assistance;
(m) A record of any medication dosage missed or refused, that the medication assistance provider documented, by drawing a circle around the appropriate space on the APD Form 65G7-00 and initialing it; and
(n) The reasons for not administering a medication, that the medication assistance provider initialed and annotated in the comments section using the following system, or a comparable numbering and coding system containing the same information: 1 – home, 2 – work, 3 – ER/hospital, 4 – refused, 5 – medication not available, 6 – held by MD , 7 – other (explain on back of MAR).