LDSS-7005. Medication Error Report Form

Form LDSS-7005, the Medication Error Report Form, is a form used by the New York State Office of Children and Family Services to record medication errors that occur in residential care facilities.

The form is composed of several sections, including the facility name, the name and contact information of the person submitting the form, the date the error occurred, the name of the person affected, and the type, description, and outcome of the error. These sections provide necessary information for the agency to record and investigate the incident.

Important fields in this form include the date of the medication error, the type of medication involved, the type of error, the effects of the error, and any additional notes or comments. It is important to complete these fields accurately and in detail in order to provide the agency with the necessary information to investigate the incident.

An example of a situation where this form would be used is when a medication error occurs in a residential care facility. The form should be completed and submitted to the New York State Office of Children and Family Services as soon as possible after the incident. This form can be used to document the error, provide information for an investigation, and help prevent similar errors from happening in the future.

When filling out the form, be sure to provide as much detail as possible in all of the fields. In addition, any additional documents or records related to the incident should also be submitted with the form. Other forms that may be related to this form include the NYS Incident Report Form and the NYS Incident Investigation Form.