Form LIC 622B. Psychotropic Medication Administration Record (MAR)

The LIC 622B form, also known as the Psychotropic Medication Administration Record (MAR), is a vital document regulated by the California Department of Social Services' Community Care Licensing. This form serves as a comprehensive record for administering psychotropic medications in various care facilities.

The primary purpose of the LIC 622B form is to ensure accurate and detailed documentation of psychotropic medication administration for individuals under care. It is typically used in licensed community care facilities such as assisted living homes, residential care facilities, and similar establishments.

The form consists of several sections that capture essential information. These sections include:

1. Resident Information: This section requires details about the individual receiving the medication, including their full name, date of birth, and identification number.

2. Medication Information: Here, important fields are provided to record the specific psychotropic medication being administered. This includes the medication name, dosage, frequency, route of administration, and any special instructions.

3. Administration Details: This section focuses on documenting the actual administration of the medication. It captures the date and time of administration, the staff member responsible, and their initials or signature to validate the process.

4. Monitoring and Observations: This part allows caregivers to note any observations or side effects related to the medication. It may require recording vital signs, behavioral changes, or other relevant information.

When filling out the LIC 622B form, it is crucial to provide accurate and complete data. Caregivers should ensure legible handwriting or use digital platforms for entry. Additionally, they must exercise caution and follow proper protocols when administering psychotropic medications to maintain residents' safety and well-being.

While the form itself does not typically require additional documents, it is essential to refer to the individual's medical orders, prescriptions, and care plans to ensure proper administration. These supporting documents help inform the caregiver about the medication regimen and any specific considerations.

Examples of practical use cases for the LIC 622B form include tracking the administration of psychotropic medications for individuals with mental health conditions, behavior management strategies, or psychiatric treatment plans. By maintaining accurate records, caregivers can monitor medication effectiveness, identify adverse reactions, and collaborate with healthcare professionals to adjust treatment plans if necessary.

Related forms in the context of psychotropic medication administration may include the Consent for Medications (LIC 624) and the Physician's Report - Adult Residential Facilities (LIC 602A). These forms serve different purposes but are often part of a comprehensive documentation process for managing medication in care facilities.

Once completed, the LIC 622B form is typically submitted to the licensing authority, namely the California Department of Social Services' Community Care Licensing. It is crucial to store the form securely in compliance with applicable privacy regulations to maintain resident confidentiality.

In summary, the LIC 622B form is a vital document used in California's community care facilities to record the administration of psychotropic medications. Its detailed sections capture essential information regarding residents, medication details, administration records, and observations. Accurate and complete data entry, adherence to protocols, and proper storage are crucial when using this form to ensure effective medication management and regulatory compliance.