RTC Mar Proposal 1-2

RTC MAR PROPOSAL
ROUTINE ORDERS
Medication
MED NAME & DOSAGE
RN STANDING ORDERS
PRN ORDERS
Time
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
8:30AM
12:30PM
INSTRUCTIONS
4:30PM
Prescribed By: FIRST LAST
8:30PM
Date: 00/00/0000
MED NAME & DOSAGE
8:30AM
12:30PM
INSTRUCTIONS
4:30PM
8:30PM
Date: 00/00/0000
MED NAME & DOSAGE
8:30AM
12:30PM
INSTRUCTIONS
4:30PM
8:30PM
Date: 00/00/0000
Page 1
IT Interface Notes
ROUTINE ORDERS
Medication
MED NAME & DOSAGE
RN STANDING ORDERS
PRN ORDERS
Time
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
8:30AM
12:30PM
INSTRUCTIONS
4:30PM
8:30PM
Date: 00/00/0000
Levothyroxin 75MCG
Generic for: Synthroid
Take 1 Tablet By Mouth

In the Morning
Prescribed By: Holly Smith
Med & Dosage:
Haldol 10MG
Generic Name:
Haloperidol 10MG
Instructions:
Take 1 tablet by mouth twice daily
Prescriber:
Holly Batchelor
Start Date:
05/04/2014
8:30AM
Med Times:
Is medication controlled? Yes
No
Date: 3/17/14
Did Medical Director approve controlled? Yes

Does medication have titration orders? Yes
Page 2
No
No
Med Entry
ROUTINE ORDERS
Medication
Levothyroxin 75MCG
RN
STANDING
MA
Standing ORDERS
Orders
PRN ORDERS
Time
8:30AM
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
Medication Discontinued
In the Morning
Per Provider. 5/7/2014, JT
Prescribed By: Holly Batchelor

Date: 3/17/14
Haloperidol 10MG
8:30AM
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
8:30PM
8:30AM
JT/KK JT/KK JT/KK

Twice Daily

Date: 5/4/14
Azithromycin 235mg
Medication Completed
New Order
5/6/2014, BL
Twice Daily for 10 days.
8:30PM
JT/KK JT/KK JT/KK JT/KK
Date: 5/6/14
Page 3
Routine Orders
ROUTINEARORDERS
Medication
Levothyroxin 75MCG
RN
ORDERS
MRSTANDING
Standing Orders
PRN ORDERS
Time
7:00AM
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
Client name: Patient

ZzzTest Discontinued
Medication
In the Morning Before
Med and dosage: Haloperidol 10MG
Breakfast
Instructions: Take 1 tablet by mouth twice daily

Date: 3/17/14
Haloperidol 10MG
Date and Time Filtered: 05/03/2014 8:30am

8:30AM
JT/KK
8:30PM
8:30AM
JT/KK JT/KK JT/KK
o
o
o
o
o
o
o

Twice Daily
Self administered as prescribed ( % )

Injection offsite (IOS)
Consumer bedhold (+)
Medication not available ()
Missed Med (*)
Refusal (R)
System Error (#)
Hold (H)
Date: 5/4/14
Clonazepam 1MG
Titration Schedule Completed
New Order
5/6/2014, BL
8:30PM
Date: 5/6/14
Page 4
Routine Orders popup
ROUTINE ORDERS
Medication
RN STANDING ORDERS
PRN ORDERS
Time
ProAir HFA AER
2
JT/KK
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
JT/KK
Generic for: Albuterol Sulfate

JT/KK
JT/KK
JT/KK
JT/KK
Inhale 2 puffs into lungs every

four hours as needed for
shortness of breath
Prescribed by: Dawn Laprade NP
JT/KK
Date: 03/26/2014
Tramadol HCL 50mg
8:30AM
JT/KK JT/KK
4:30PM
JT/KK JT/KK
JT/KK
Generic for: Ultram 50mg

Twice Daily As Needed
for 10 days.
Prescribed by: Amit Patel
Date: 4/30/2014
Hydrocortisone Cream 2.5% 8:30AM
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
Generic for: Hytone Cream 2.5%
12:30PM
Apply Four Times Daily

As Needed
4:30PM
Prescribed by: Dawn E. LaPrade, NP8:30PM
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
5/9/2014, JT
JT/KK
Date: 04/28/2014
Page 5
PRN's
ROUTINE ORDERS
Medication
RNMA
STANDING
StandingORDERS
Orders
PRN ORDERS
Time
ProAir HFA AER
JT/KK
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Client name: Patient ZzzTest

JT/KK
JT/KK
JT/KK
JT/KK
Med and dosage: Tramadol HCL 50mg

Instructions: Take 1 tablet by mouth twice daily as needed

for 10 days.
shortness of breath
Date and Time: 05/03/2014 8:30am
JT/KK
Date: 03/26/2014
Remaining Narcotic Count AFTER Administration:

8:30AM
JT/KK
JT/KK JT/KK
o
o
o
o

4:30PM
14
JT/KK
31
JT/KK
Tramadol HCL 50mg
30
Self administered as prescribed ( % )

System Error (#)
Hold (H)
JT/KK JT/KK
for 10 days.
Date: 4/30/2014
Hydrocortisone Cream 2.5% 8:30AM
Generic for: Hytone Cream 2.5%
12:30PM
Apply Four Times Daily

As Needed
4:30PM
Prescribed by: Dawn E. LaPrade, NP8:30PM
5/9/2014, JT
JT/KK
Date: 04/28/2014
Page 6
PRN's popup
ROUTINE ORDERS
MR PRN's
PRN
ORDERS
Medication
Ibuprofen 200mg
RN STANDING ORDERS
3
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
JT/KK JT/KK JT/KK JT/KK JT/KK
TAKE 1 TABLET EVERY 4-6 HRS. DO NOT

EXCEED 6 TABLETS IN 24 HRS. CALL
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
PROVIDER IF PAIN GETS WORSE OR

LASTS MORE THAN 10 DAYS
JT/KK JT/KK
Per C. Nies, RN 5/11/2014, JT
JT/KK
OR FEVER LASTS MORE THAN 3 DAYS.
Approved by: C. Nies, RN
JT/KK
Date: 4/24/2014
Skin Care- Triple Antibiotic

Ointment, Antifungal Cream,
Client name: Patient ZzzTest
or Hydrocortisone Cream-
Med and dosage: Ibuprofen 200mg
use as directed. See a provider

if too much irritation occurs
Instructions: Take 1 tablet every 4-6 hrs. Do not exceed 6 tablets

in 24 hrs. Call provider if pain gets worse or lasts more than 10
days or fever lasts more than 3 days.
or gets worse.
Date: 5/3/2014
Loperamide 2mg tablets-
Approved by:
2 tablets by mouth subsequent

to first loose stool and then
1 tablet by mouth every 4 hrs
as needed for diarrhea up to
16mg a day.
Approved by:
Date:
Page 7
StandingOrders
ROUTINE ORDERS
RN STANDING ORDERS
PRN ORDERS
Medication
Ibuprofen 200mg
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31


JT/KK JT/KK
JT/KK
Per C. ZzzTest
Nies, RN 5/11/2014, JT
Med and dosage: Ibuprofen 200mg
JT/KK
Date: 4/24/2014
Instructions: Take 1 tablet every 4-6 hrs. Do not exceed 6

tablets in 24 hrs. Call provider if pain gets worse or lasts
more than 10 days or fever lasts more than 3 days.
Skin Care- Triple Antibiotic

Ointment, Antifungal Cream,
or Hydrocortisone Cream-
Date and Time: 05/03/2014
use as directed. See a provider
Pain Level:
if too much irritation occurs
or gets worse.
Pain Site:
head
Self-Administered as approved by RN
Date: 4/24/2014
Loperamide 2mg tablets2 tablets by mouth subsequent

to first loose stool and then
1 tablet by mouth every 4 hrs
as needed for diarrhea up to
16mg a day.
Approved by:
Date:
Page 8
Standing Orders popup
ROUTINE ORDERS
Medication
Prednisone 2mg
MARStanding
Orders
RN
STANDING ORDERS
PRN ORDERS
Time
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
7:00AM
JT/KK JT/KK
12:30PM
JT/KK JT/KK
dinner and 1 at bedtime.
4:30PM
JT/KK JT/KK
8:30PM
JT/KK JT/KK
30
31
Days 1 and 2:
Take 1 tablet by mouth at
Titration schedule,
see new entry
5/9/2014, BL
breakfast, 2 at lunch, 2 at
Date: 5/7/14
Prednisone 2mg
7:00AM
JT/KK JT/KK
12:30PM
JT/KK JT/KK
8:30PM
JT/KK JT/KK
Days 3 and 4:
Titration schedule,
see new entry
5/11/2014, BL
breakfast, 1 at lunch,
and 1 at bedtime.

Date: 5/7/14
Prednisone 2mg
7:00AM
JT/KK
Day 5:
Medication
Completed
5/12/2014, BL

breakfast and 1 at bedtime.
8:30PM
JT/KK
Date: 5/7/14
Page 9
ComplexTitration
ROUTINEARORDERS
Medication
Levothyroxin 75MCG
RN
ORDERS
MRSTANDING
Standing Orders
PRN ORDERS
Time
7:00AM
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31

ZzzTest Discontinued
Medication
In the Morning Before
Med and dosage: Haloperidol 10MG
Breakfast
Instructions: Take 1 tablet by mouth twice daily

Date: 3/17/14
Haloperidol 10MG
Date and Time Filtered: 05/03/2014 8:30am

8:30AM
JT/KK
8:30PM
8:30AM
JT/KK JT/KK JT/KK
o
o
o
o
o
o
o

Twice Daily
Self administered as prescribed

Missed Med (*)
Refusal (R)
System Error (#)
Hold (H)
Date: 5/4/14
Clonazepam 1MG
Titration Schedule Completed
New Order
5/6/2014, BL
8:30PM
Date: 5/6/14
Page 10
Option1acknowledgement
Page 11 Option2Acknowledgment
Medication Administration Record

NAME: ZZZTest Patient
Medication
Levothyroxin 75MCG
Time
8:30AM
DOB: 12/09/1982
7
ALLERGIES:
Penicillin
Page 1 of 2
Month: May 2014
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31
In the Morning

Date: 3/17/14
Haloperidol 10MG
8:30AM
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/R
JT/R
JT/KK JT/KK JT/KK JT/KK JT/+ JT/+ JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
8:30PM
JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/R
JT/R
JT/R

Twice Daily
JT/KK JT/KK JT/KK JT/+ JT/KK JT/KK JT/H JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK
Date: 5/4/14
Azithromycin 235mg
8:30AM
New Order
5/6/2014, BL
8:30PM
Date: 5/6/14
Legend:
Missed Med (*)

Refusal (R)
Page 12
System Error (Sys)

Hold (H)
GeneratedMAR
Medication Administration Record

NAME: ZZZTest Patient
Medication
Time
ProAir HFA AER
JT/KK
DOB: 12/09/1982
7
ALLERGIES:
Page 2 of 2
Penicillin
Month: May 2014
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
JT/KK
30
31

JT/KK
JT/KK
JT/KK
JT/KK
JT/KK

JT/KK
shortness of breath
JT/KK
JT/KK
JT/KK
Date: 03/26/2014
Tramadol HCL 50mg
8:30AM
JT/KK JT/KK
JT/KK
Medication
Completed
5/8/2014, BL

4:30PM
JT/KK JT/KK
for 10 days.
Date: 4/30/2014
Ibuprofen 200mg


JT/KK
Per C. Nies, RN 5/11/2014, JT
JT/KK
JT/KK
Date: 4/24/2014
Legend:
Missed Med (*)

Refusal (R)
Page 13
System Error (Sys)

Hold (H)
Generated MAR2

RTC Mar Proposal 1-2

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RTC MAR PROPOSAL

Prescribed By: FIRST LAST

MED NAME & DOSAGE

Prescribed By: FIRST LAST

MED NAME & DOSAGE

Prescribed By: FIRST LAST

Prescribed By: FIRST LAST

Take 1 Tablet By Mouth

Prescribed By: Holly Smith

Med & Dosage:

Take 1 tablet by mouth twice daily

Is medication controlled? Yes

Did Medical Director approve controlled? Yes

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

Generic for: Synthroid

Take 1 Tablet By Mouth

Per Provider. 5/7/2014, JT

Prescribed By: Holly Batchelor

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

JT/KK JT/KK JT/KK

Take 1 Tablet By Mouth

Prescribed By: Holly Batchelor

Take 1 Tablet By Mouth

Per Provider. 5/16/2014, JT

Twice Daily for 10 days.

Prescribed By: Holly Batchelor

JT/KK JT/KK JT/KK JT/KK

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

Generic for: Synthroid

Take 1 Tablet By Mouth

Client name: Patient

In the Morning Before

Per Provider. 5/7/2014, JT

Med and dosage: Haloperidol 10MG

Instructions: Take 1 tablet by mouth twice daily

Prescribed By: Holly Batchelor

Date and Time Filtered: 05/03/2014 8:30am

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

JT/KK JT/KK JT/KK

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

Take 1 Tablet By Mouth

Prescribed By: Holly Batchelor

Self administered as prescribed ( % )

Titration Schedule Completed

Take 1 Tablet By Mouth

Per Provider. 5/16/2014, JT

Twice Daily for 10 days.

Prescribed By: Holly Batchelor

JT/KK JT/KK JT/KK JT/KK

Routine Orders popup

ProAir HFA AER

Generic for: Albuterol Sulfate

Inhale 2 puffs into lungs every

Tramadol HCL 50mg

Generic for: Ultram 50mg

Take 1 Tablet By Mouth

Hydrocortisone Cream 2.5% 8:30AM

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

Generic for: Hytone Cream 2.5%

JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK JT/KK

Apply Four Times Daily