Company

LOGO

Leave of AbsenceLeave of Absence

Medication Education Module 5Medication Education Module 5

Company

LOGO ObjectivesObjectives

Company

LOGO Leave of AbsenceLeave of Absence Meds administered Meds administered

outside of an individual’s outside of an individual’s residenceresidence Day programDay program Day-habDay-hab Relative’s homeRelative’s home Outing with MAP Certified staffOuting with MAP Certified staff Vacation with MAP Certified staffVacation with MAP Certified staff

Company

LOGO LOA MedsLOA Meds Must be prepared by a Must be prepared by a

pharmacist forpharmacist forRoutine absences less Routine absences less

than 72 hrs.than 72 hrs. Extended absences Extended absences

(planned or unplanned) (planned or unplanned) greater than 72 hrs.greater than 72 hrs.

Company

LOGO LOA MedsLOA MedsIfIf a LOA is a LOA is

unplanned unplanned less than 72 hrs. less than 72 hrs. the pharmacist is unable the pharmacist is unable

to prepare the medsto prepare the meds

ThenThen Certified staff may Certified staff may

prepare the medsprepare the meds

Company

LOGO LOA MedsLOA Meds Separate container for each Separate container for each

type of medtype of med Package only exact number Package only exact number

of doses neededof doses needed Transfer medication from original Transfer medication from original

card/container directly into LOA card/container directly into LOA containercontainer

Company

LOGO

Copy required information Copy required information directly on containerdirectly on container

Coin envelopes are Coin envelopes are acceptableacceptable

LOA MedsLOA Meds

Company

LOGO Information on ContainerInformation on Container

Individual’s nameIndividual’s name Name and strength of Name and strength of

medicationmedication Directions for useDirections for use Prescribing HCP namePrescribing HCP name Date of dispensingDate of dispensing Any cautionary statementsAny cautionary statements Amount of med in the containerAmount of med in the container

Company

LOGO LOA FormLOA Form Must be signed byMust be signed by

The Certified staff The Certified staff handing over the LOA handing over the LOA meds meds andand

Responsible party Responsible party accepting the LOA accepting the LOA meds meds

Company

LOGO

Name: Joseph Smith q Original EntryDoctor: Paula Whiten x Transfer from page 2r from pg 10Pharmacy: Cornerstone Prescription Number: D388857Medication Prescription n Date 08/05/yr& Strength: Ativan 0.5mg Prescription Number: Directions: Take 1 tab by mouth twice daily Prescription Date:

Date Time Amount Amount Amount Signatureon Hand Used Left

08/30/yr 8:00 PM 9 Transfer 9 Karen Mason/Lisa Long

09/01/yr 8:00 AM 9 one 8 Karen Mason

09/01/yr 8:00 PM 8 one 7 Lisa Long09/02/yr 8:00 AM 7 one 6 Karen Mason

09/02/yr10:00am 6 two/LOA 4 Karen Mason09/03/yr 8:00 PM 4 one 3 Pamela Smith

LOA DocumentationLOA DocumentationPage 11Page 11

Company

LOGO

Name: Joseph Smith Month/Year: Sept. yr Allergies: NKDA

Dates Medication Hour 1 2 3 4 5 6

Start: 6/22/yr

Generic: Lorazepam Brand: Ativan

8am

KM

KM LOA

LL

Strength:0.5mg Amount: one tab

Stop: Cont.

Dose: 0.5mg Frequency: twice daily

Route: by mouth

8pm

LL

LOA

PS

SPECIAL INSTRUCTIONS/REASON: agitation

LOA DocumentationLOA Documentation

Company

LOGO Unused LOA MedicationsUnused LOA Medications

Unused Unused oraloral LOA meds LOA meds cannot be returned to the cannot be returned to the program for useprogram for use Follow DPH disposal Follow DPH disposal

guidelines guidelines Topicals, eye drops, ear Topicals, eye drops, ear

drops, inhalers may go drops, inhalers may go back and forthback and forth

Company

LOGO Staffed LOA VacationsStaffed LOA Vacations Meds are prepared by the Meds are prepared by the

pharmacypharmacy Copies of Copies of

HCP OrdersHCP Orders Medication SheetsMedication Sheets Medication Information SheetsMedication Information Sheets

All policies regarding drug All policies regarding drug security are observedsecurity are observed

List of MAP ConsultantsList of MAP Consultants

Company

LOGO QuestionsQuestions