California Medication Administration Record (MAR) Form

Submit the completed MAR form to the appropriate facility or agency as required. Ensure all sections are accurately filled out before submission. Follow your facility's or agency's policy for submitting the form, which may include emailing to the designated address, faxing to the provided number, or submitting through an online form. Always keep a copy of the form for your records. Advice: Always double-check the information before submission to avoid errors and ensure compliance with state regulations.

Ensure timely requests for refills by monitoring the Quantity Prescribed section and noting the Anticipated Refill Date. Regularly update the MAR form with any new medications, allergies, or observed side effects.

The California Medication Administration Record (MAR) Form serves as a vital tool for documenting the administration of non-psychotropic medication to children in licensed Community Care facilities, foster homes, and resource family agencies. This form ensures that medications are taken correctly and at the appropriate times, helping to maintain the health and well-being of children in care. Additionally, the form provides sections for noting allergies, observed side effects, and monthly weight records. By maintaining accurate and up-to-date records, caregivers and healthcare professionals can monitor the child's response to medications and address any issues that may arise. Furthermore, the MAR form helps facilities and agencies comply with state regulations, ensuring proper medication management and documentation practices.

• 1. Child's Name: Enter the full name of the child taking the medication.
• 2. Date of Birth: Enter the child's date of birth.
• 3. Sex: Enter the child's biological sex as listed in their file.
• 4. Facility Name & Number or Foster/Certified/Resource Family Agency Name: Enter the name of the licensed Community Care facility or home where the child resides.
• 5. MO/YR: Enter the month and year the information in the log was documented.
• 6. Prescription Details: Enter medication name, required dosage, time and frequency of dose, quantity prescribed, prescription filled date, prescription number, and number of refills.
• 7. Allergies: Enter any known allergies to food, medication, etc.
• 8. Monthly Weight & Date: Enter the child's weight and the date it was taken.
• 9. Anticipated Refill Date: Enter the date the medication will need to be refilled.
• 10. Pharmacy Name & Number: Enter the pharmacy's name and phone number.
• 11. Physician Name & Number: Enter the prescribing physician's name and phone number.
• 12. Additional Instructions From Physician: Enter any additional instructions from the prescribing physician.
• 13. Placement Worker Name & Number: Enter the placement worker's name and phone number.
• 14. Date and Description of Any Observed Side Effects: Document the date and description of any observed side effects or changes in the child's behavior.

Failing to submit the MAR form can result in inaccurately documented medication administration and potential health risks for the child.

• Inaccurate Medication Records: Incomplete or missing records may lead to incorrect dosages and medication errors.
• Health Risks: Lack of proper documentation may result in unmonitored side effects and potential health complications for the child.
• Non-compliance: Failure to submit the form as required can lead to non-compliance with state regulations and potential legal issues for the facility or agency.

• 1. Medication Administration: Record the details of each medication given to the child, including time, dosage, and frequency.
• 2. Monitor Allergies: Document any known allergies to food or medication in the designated section.
• 3. Track Side Effects: Monitor and record any observed side effects or changes in the child's behavior.
• 4. Document Monthly Weight: Keep track of the child's weight on a monthly basis to monitor their overall health.
• 5. Ensure Timely Medication Refills: Determine the anticipated refill date and ensure timely requests for refills based on the quantity prescribed.