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CA LIC 622 1999-2026 free printable template
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Medication records on each client/resident shall be maintained for at least one year. NAME LAST MEDICATION NAME LIC 622 3/99 CONFIDENTIAL FIRST STRENGTH/ QUANTITY MIDDLE CONTROL/CUSTODY EXPIRATION DATE ADMISSION DATE FILLED STARTED ATTENDING PHYSICIAN PRESCRIBING PHYSICIAN ADMINISTRATOR PRESCRIPTION NO. STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING CENTRALLY STORED MEDICATION AND DESTRUCTION RECORD FACILITY NAME INSTRUCTIONS...Centrally stored medications shall be kept in a safe and locked place that is not accessible to any person s except authorized individuals. OF NUMBER REFILLS NAME OF PHARMACY II. MEDICATION DESTRUCTION RECORD Designated Representative and witnessed by one other adult who is not a client/resident. All facilities except Residential Care Facilities for the Elderly RCFEs shall retain destruction records for at least one year. RCFEs shall retain records for at least three years. DATE FILLED...PRESCRIPTION DISPOSAL NAME OF PHARMACY SIGNATURE OF ADMINISTRATOR OR DESIGNATED REPRESENTATIVE SIGNATURE OF WITNESS ADULT NON-CLIENT. OF NUMBER REFILLS NAME OF PHARMACY II. MEDICATION DESTRUCTION RECORD Designated Representative and witnessed by one other adult who is not a client/resident. All facilities except Residential Care Facilities for the Elderly RCFEs shall retain destruction records for at least one year. All facilities except Residential Care Facilities for the Elderly RCFEs shall...retain destruction records for at least one year. RCFEs shall retain records for at least three years. DATE FILLED PRESCRIPTION DISPOSAL NAME OF PHARMACY SIGNATURE OF ADMINISTRATOR OR DESIGNATED REPRESENTATIVE SIGNATURE OF WITNESS ADULT NON-CLIENT. OF NUMBER REFILLS NAME OF PHARMACY II. MEDICATION DESTRUCTION RECORD Designated Representative and witnessed by one other adult who is not a client/resident. All facilities except Residential Care Facilities for the Elderly RCFEs shall retain...destruction records for at least one year. RCFEs shall retain records for at least three years. DATE FILLED PRESCRIPTION DISPOSAL NAME OF PHARMACY SIGNATURE OF ADMINISTRATOR OR DESIGNATED REPRESENTATIVE SIGNATURE OF WITNESS ADULT NON-CLIENT.
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Understanding the CA 622 () Form
What is the CA 622 () Form
The CA LIC 622 () form is a document required by the California Department of Social Services for community care licensing. It serves as a centrally stored medication and destruction record for facilities, ensuring that medications are managed safely and in accordance with state regulations. This form is integral for maintaining proper oversight of medication control within licensed facilities.
Key Features of the CA 622 () Form
This form includes vital components such as medication name, strength, quantity, prescription details, and scheduled destruction procedures. Facilities must keep a detailed record of client medication, including admission dates, prescribing and attending physician information, and control and custody instructions. All records facilitate easy tracking and compliance with health regulations.
When to Use the CA 622 () Form
The CA LIC 622 form should be used whenever a facility stores medications centrally or disposes of them. It is necessary for documenting medications administered to clients or residents and their respective management processes. Accurate use of this form is essential during audits and inspections by health authorities.
Required Documents and Information
To complete the CA LIC 622 form accurately, several key pieces of information are required. This includes basic facility information, detailed medication information (name, strength, quantity), prescription numbers, and signatures from the administrator or designated representative. Ensuring that this data is logged correctly promotes compliance and facilitates effective medication management.
Best Practices for Accurate Completion
To ensure that the CA LIC 622 form is filled out accurately, facilities should adopt a systematic approach. Double-check entries for correctness, ensure that all required fields are completed, and maintain clear records of medication management. Regular training sessions for staff on the importance of compliance and correct form usage can also enhance overall accuracy.
Common Errors and Troubleshooting
Common errors in completing the CA LIC 622 form include missing information, incorrect medication details, and improper signatures. It is advisable to create a checklist for verifying all entries before submission. Addressing these usual mistakes proactively can prevent delays and compliance issues, ensuring smooth operation within care facilities.
Frequently Asked Questions about lic 622 form
Who needs the CA LIC 622 () form?
The CA LIC 622 form is needed by community care facilities that handle centrally stored medications, ensuring adherence to California's licensing requirements.
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People Also Ask about lic622
How do I fill out a mar sheet?
MAR charts include important information such as: Name of the resident. Time and dates the medication is to be taken. Names of the medications prescribed. Dosage of the medication. Initials of the person administering the medication.
What is centrally stored medication?
I. CENTRALLY STORED MEDICATION. INSTRUCTIONS: Centrally stored medications shall be kept in a safe and locked place that is not accessible to any person(s) except authorized individuals. Medication records on each client/resident shall be maintained for at least one year.
What is the purpose of a medication administration record?
You can use a Medication Administration Record (MAR) to help you keep track of every dose that the individual you support takes or misses for whatever reason. A MAR includes key information about the individual's medication including, the medication name, dose taken, special instructions and date and time.
What are the advantages of medication administration record?
From documenting to administering, medication errors can occur anytime. With eMAR, the chances of errors are reduced, and no dosage is missed. 5. Without eMAR, the staff spends most of their time searching the paper and going through other documents.
What is the purpose of a mar chart?
Purpose of the MAR chart: MAR charts are the formal record of administration of medicine within the care setting and may be required to be used as evidence in clinical investigations and court cases. It is therefore important that they are clear, accurate and up to date.
What is LIC 622?
• Every non-prescription medication. centrally stored in the facility should be logged similar to prescribed medications. The Centrally Stored Medication and Destruction Record (LIC 622) is available for this purpose. Page 4. COMMUNITY CARE LICENSING DIVISION.
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