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BEERS List
Exception Form
*Medicare×MEDICARE RESTRICTED
Request for Drug Evaluation FAX: 18009562397
Please complete All the following:
Patient Information:
Patient Name (Please print):
Patient ID#:Patient
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What is beers list?
Beers list is a list of potentially inappropriate medications for elderly patients.
Who is required to file beers list?
Healthcare providers and facilities are required to file beers list.
How to fill out beers list?
Beers list can be filled out by documenting medications prescribed to elderly patients and comparing them to the list of potentially inappropriate medications.
What is the purpose of beers list?
The purpose of beers list is to improve the safety and quality of medication use in elderly patients.
What information must be reported on beers list?
Information such as patient's name, medications prescribed, dosage, and frequency must be reported on beers list.
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