Medication Administration Record

Who this is for

A signed record of what was given and when. The first table lists each medicine as written on its label and who prescribed it; the second is filled in at the moment of giving it — date, medicine, time, who gave it, their initials, and the reason if it was refused or withheld.

Family carers giving medicines to a relative, personal assistants and agency carers who are asked to keep a record in the home, and anyone handing that record to a nurse, pharmacist or doctor who wants to know what was actually taken.

What this helps you track

• Each medicine listed exactly as its label reads, with who prescribed it
• Every administration with the date, time and the initials of the person who gave it
• Refusals and withheld doses with the reason, written at the time
• A signature and printed name so the record stands on its own
• One sheet the next carer, the pharmacy and the prescriber can all read

How to use it

1. Write the person's details, their prescriber and their pharmacy at the top.
2. Copy each medicine into the first table word for word from the label on the box or bottle, and write in who prescribed it.
3. When a medicine is given, add a line to the second table straight away: date, medicine, time, who gave it, initials.
4. If it was refused or not given, write the reason on the line and report it to whoever the care plan names.
5. Sign and print your name at the foot when the sheet is full or the period ends.
6. Keep the completed sheets together with the medicines, or fill it in online and save it in your own browser.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Does the sheet tell me what to give or when?

No. There is no dose, no timing, no frequency and no drug name anywhere on it. Every entry is copied from the prescription label or from the prescriber's written instructions, which are the only instructions to follow.

What if a medicine is refused?

Write the line as usual, put the reason in the refused or withheld column, and report it to whoever the care plan names. Do not decide anything about it yourself; the record is for the person who does.

Who is allowed to fill this in?

That is decided by the care plan, the prescriber and the rules where you are, not by this sheet. It records who gave what and when, and that is all it does.

Is this the same as the medication record and repeat list?

No. That sheet is a list of what somebody takes and the ordering of repeats. This one is the administration record — each time a medicine is actually given, signed for on the line.