Medication Administration Record (MAR)
Medication Administration Record (MAR) Name: _________________________________ Month: ______________ Year:________
Medication/ dosage/
frequency/route
Time 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Initial Signature
Known allergies or adverse reactions:
PRN AND REFUSED MEDICATION NOTES
Date/Time Medication/Dosage
Reason
Results
Hour/Initials
Vital signs or other tracking per physician or team request: Date: _________ Date: _________ Date: _________ Date: _________ Date: _________
Weight Blood Pressure Temperature Pulse Other:
Date: _________
................
................
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