* = Required Information
First Friday Lead Meeting Paperwork Submission

Included (Yes/No)

Not Included/Why (give a reason)

Medication Forms

Med Administration Records

Yes No

Medication Receipt Forms

Yes No

Medication Release Forms

Yes No

Blood Sugar Log (If applicable)

Yes No
Form Name

Health Progress Notes (If applicable)

Yes No

Monthly Data Tracking Sheets

Yes No
Referral Forms

Annual Physical Form

Yes No

Standing Orders/Over the Counter Meds (If a resident has a physical we need the standing orders signed by Physician, the original comes to the office and, a copy goes in the resident book on site)

Yes No

Authorization for injection

Yes No

Psychotropic Medication Evaluation

Yes No

Dentist Visit Form

Yes No

Ophthalmology Visit Form

Yes No

Medical Referral Form

Yes No

Authorization for injection

Yes No

Lab Referral Form

Yes No

Physician’s Orders (Prescriptions etc.)

Yes No

Moses and/or Discus (if ordered by the doctor)

Yes No

Sleep Charts (For specified individuals)

Yes No
Other

Mail

Yes No

SSI Paperwork

Yes No

NARC Count

Yes No

Misc. Docs

Yes No

All paperwork listed above will be collected by the lead, placed in the house packet/folder and brought to Monneapolis each month on the day of the First Friday of the Month Lead Meeting.

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