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SELF ADMINISTRATION OF MEDICATION (SAM) ASSESSMENT TOOL Name: QM RP/Case Manager: Residence: Nurse: Evaluate the individual's ability to participate in a self-medication program by placing a check
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How to fill out self administration of medication:

01
Read and understand the medication instructions: Before starting the self administration of medication, it is important to carefully read and understand the instructions provided by the healthcare professional or pharmacist. Take note of the dosage, frequency, and any special instructions related to the medication.
02
Gather the necessary supplies: Make sure you have all the necessary supplies ready before starting to administer the medication. This may include the medication itself, a glass of water, a pill organizer or packaging, a syringe, or any other equipment specified in the instructions.
03
Wash your hands: Cleanliness is crucial when handling medication. Thoroughly wash your hands with soap and water to minimize the risk of infection or contamination. Dry your hands with a clean towel or tissue.
04
Use appropriate techniques: Depending on the type of medication, there may be different techniques for administration. For example, if it is an oral medication, swallow the pill with water as directed. If it is a subcutaneous injection, follow the recommended procedure for injecting the medication.
05
Monitor for side effects or reactions: After administering the medication, it is important to be vigilant for any potential side effects or adverse reactions. If you experience any unexpected symptoms or reactions, consult your healthcare provider immediately.

Who needs self administration of medication:

01
Patients with chronic diseases: Individuals with chronic diseases such as diabetes, hypertension, or asthma may need to self-administer medication on a regular basis to manage their condition.
02
Individuals with certain disabilities: Some individuals with physical disabilities or cognitive impairments may need to self-administer medication if they live independently or do not have constant access to a caregiver.
03
People practicing self-care at home: In certain situations, individuals may prefer to administer their medication at home instead of visiting a healthcare facility. This can include people recovering from surgery, managing mild illnesses, or taking preventive medications.
Remember, it is essential to consult with a healthcare professional before starting self administration of medication. They can provide personalized instructions and guidance based on your specific medical condition and needs.
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Self administration of medication refers to the practice of individuals managing and taking their medication independently without the need of a healthcare provider.
Individuals who are capable of managing and taking their own medication are required to file for self administration of medication.
To fill out self administration of medication, individuals need to provide detailed information about the medications they are taking, dosages, frequency, any special instructions, and contact information of their healthcare provider.
The purpose of self administration of medication is to ensure that individuals are able to manage their medications safely and independently, without relying on external assistance.
The information that must be reported on self administration of medication includes the name of the medication, dosage, frequency, any special instructions, and contact information of the healthcare provider.
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