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Medication Administration Record MAR MO/YR Medication Start/Stop Date Facility Name Hour Start Stop Diagnosis Allergies DIET Special Instructions e.g. Texture Bite Size Position etc. Physician Name A. B. C. D. E. Phone Number NAME Comments Record Put initials in appropriate box when medication is given. Circle initials when not given. State reason for refusal / omission on back of form. PRN Medications Reason given and results must be noted on back of form. Legend S School H Home visit W Work...

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