Drug Regimen Review - MDS/SNF QRP
| Color | White |
|---|---|
| MPN | 3601P |
| Brand | Briggs Health Care |
| Packaging | 100 per pad |
| Size | 8-1/2In x 11In |
Note : Image shown for reference purposes only. Actual product appearance may vary. Please read product description for full and accurate details.
3601P serves as a record for documenting the Drug Regimen
Reviews that are conducted at the admission of a resident for skilled Part A
PPS services as well as throughout that skilled stay. The form
includes:
Specific data as to date and time of
admission DRR, etc.
Identification when no issues are
identified during DRR and no further action is needed
Reason(s) for identification of potential
or actual clinically significant medication issues
Clinician comments re: reason for referral
to physician/physician designee
Specific data as to date and time of
physician notification and response
Specific data as to Recommended/Prescribed
Action
Specific data as to completion of
prescribed action
Back side of form provides for 2
additional Drug Regimen Reviews during the resident's skilled stay, as needed/appropriate.
White with black ink
5-hole punched top and side
100 per pad
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