Medication Pass Worksheet {CMS-677} | Pdf Fpdf Doc Docx | Official Federal Forms

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Medication Pass Worksheet {CMS-677} | Pdf Fpdf Doc Docx | Official Federal Forms

Medication Pass Worksheet {CMS-677}

This is a Official Federal Forms form that can be used for Centers For Medicare And Medicaid Services.

Alternate TextLast updated: 5/2/2006

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Description

DEPARTMENTOF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICATION PASS WORKSHEET Provider Number Surveyor Name Date Error Rate Instructions: 1. Observe Pass for 20-25 opportunities for error. If one or more errors is found observe another 20-25 opportunities for error. 2. Record your observation of each opportunity for error. 3. Compare your record with physician orders. 4. Calculate and note error rate Deficiency Formulas: Significant Error + Non-Significant Error X 100 = 5% = Deficiency 1. One or more Significant Errors = Deficiency 2. Doses given + Doses ordered but not given Identifier Pour Pass Record Drug Prescription Name, Drug Order Written As Residents Full Name Observation of Administration Dose and Form (when different from observation)FORM CMS-677 (07/95) <<<<<<<<<********>>>>>>>>>>>>> 2 MEDICATION PASS WORKSHEET Identifier Pour Pass Record Drug Prescription Name, Drug Order Written As Residents Full Name Observation of Administration Dose and Form (when different from observation)FORM CMS-677 (07/95)

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