Medication Log
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Medication Log as PDF for free.
More details
- Words: 172
- Pages: 1
MH 519 Revised 06/29/08
MEDICATION LOG
Prescriptions must be documented using one of these Department required Medication Support forms: • MH 657 Initial Medication Support Service (90862) • MH 653 Complex Medication Support Service (90862) • MH 655 Brief Follow-up Medication Support Service (M0064 or H2010) At clinics that choose to maintain medication history reference, physicians may use this OPTIONAL form as an additional place to document medications prescribed to a client. Date
Name
Dosage
This confidential information is provided to you in accord with State and Federal laws and regulations including but not limited to applicable Welfare and Institutions code, Civil Code and HIPAA Privacy Standards. Duplication of this information for further disclosure is prohibited without prior written authorization of the client/authorized representative to whom it pertains unless otherwise permitted by law. Destruction of this information is required after the stated purpose of the original request is fulfilled.
Frequency
Route of Admin
Amount
Name:
IS#:
Agency:
Provider #:
# of Refills
Los Angeles County – Department of Mental Health
MEDICATION LOG
MEDICATION LOG
Prescriptions must be documented using one of these Department required Medication Support forms: • MH 657 Initial Medication Support Service (90862) • MH 653 Complex Medication Support Service (90862) • MH 655 Brief Follow-up Medication Support Service (M0064 or H2010) At clinics that choose to maintain medication history reference, physicians may use this OPTIONAL form as an additional place to document medications prescribed to a client. Date
Name
Dosage
This confidential information is provided to you in accord with State and Federal laws and regulations including but not limited to applicable Welfare and Institutions code, Civil Code and HIPAA Privacy Standards. Duplication of this information for further disclosure is prohibited without prior written authorization of the client/authorized representative to whom it pertains unless otherwise permitted by law. Destruction of this information is required after the stated purpose of the original request is fulfilled.
Frequency
Route of Admin
Amount
Name:
IS#:
Agency:
Provider #:
# of Refills
Los Angeles County – Department of Mental Health
MEDICATION LOG
Related Documents
Medication Log
October 2019 24
Medication Log
June 2020 16
Medication Log
June 2020 14
Medication Log
June 2020 8
Medication Administration Log
June 2020 12