Medication administration record (MAR)

How to fill in a MAR at home

1. Keep it where the doses are given. The kitchen counter or a clipboard by the bed, with a pen. A record in a drawer doesn't get filled in.
2. Give the dose, then initial. Not before the dose and not at the end of the day. Initialing right after is what stops the next person from giving it again, and it's what the Open RN nursing textbook teaches nurses.If the sheet shows a dose was given twice, call Poison Control now at 1-800-222-1222. It's free and answers day and night. Call 911 if the person is hard to wake or has trouble breathing.
3. If a dose isn't given, initial its box and draw a circle around your initials. The circle tells the next person this dose wasn't given. Add a letter from the key at the bottom of the sheet (R refused, H held because a doctor or nurse said to skip it, A away, N ran out, O other) and write the reason in the notes on the last page. Don't make up a missed dose by giving two next time unless the pharmacist or doctor tells you to.
4. Fill in the initials legend. Everyone who gives doses writes their initials, printed name, and signature at the bottom once, so "AR" always means the same person. It has room for five people.
5. Log as-needed doses on the last page. Write the time, the dose, why it was given, and whether it helped. Check when the last one was given before you give another.
6. When a medicine changes, start a new line. Draw a line through the rest of the old row and write the new dose on one of the blank rows the sheet prints for this. After a hospital stay, start a fresh record from the discharge medication list instead; the hospital discharge checklist has the questions to ask about each medicine before you leave.

What's on the sheet, and where it comes from

Page one is the month: the person's name and allergies at the top, then one row for every medicine at every time it's due, with a column for each day. Short months grey out the days they don't have, and a long list runs onto more pages. The as-needed log and the notes follow the month.

Families don't have to follow any MAR rule. The sheet borrows from two rules written for paid caregivers because they solve the same problem. Florida's rule for disability service providers gives the core: each medicine's strength, dose, scheduled time and how it's given, plus the initials and signature of whoever gave it, and a circle and a written reason for a dose that was refused or missed. Oregon's adult foster home rule adds the as-needed log and a new line whenever a dose changes.

Two choices are ours. Neither rule sets letter codes, so the key is our own; cross out any letter and write yours. And the sheet has no column for the prescriber or the date each order started, which Florida asks of its providers. If your family wants them, type them into a medicine's instructions and they print on its row.

A MAR is not a medication schedule. The schedule says what is due and when; the MAR records that it happened. For doctor visits, bring a current medication list, plus the MAR when the doctor wants to know about missed doses.

A worked example: one month, four people, one sheet

Eleanor is 81 and lives with her son Jordan. Ana, an aide the family hires, comes on weekdays, and Jordan's two sisters cover weekends. Her record has five rows of scheduled doses: metformin at 8 AM and 6 PM, lisinopril at 8 AM, donepezil at 9 PM, and eye drops at 8 PM. Acetaminophen for her knee goes in the as-needed log, because she only takes it when it hurts.

On Monday Ana gives the 6 PM metformin at 5:45 and initials the box before she leaves. Jordan gets home at 6:30, sees the box is done, and doesn't give a second dose. On Tuesday evening Eleanor won't take her metformin, so Jordan circles JL, writes R, and adds a note: "said her stomach was upset, wouldn't take it." Ana reads the note the next morning and gives the usual 8 AM dose, not two.

When her doctor asks how often doses were missed this month, the answer is on paper instead of in four people's memories. If siblings are splitting the days, our caregiver handoff checklist covers what else to pass along at each switch, and the caregiver daily log holds everything that isn't a medicine.

Questions about MARs

What is a medication administration record?

It's the record nurses keep in a patient's chart of every medicine given: which one, what dose, when, and who gave it. At home it's a paper sheet like this one, with one row for each dose time and a box for every day of the month.

Can a home care agency or assisted living use this form?

It's built for families. An agency or facility has to meet its own state's MAR rules, so check those first. If your agency hands you its own MAR, use theirs.

Is there a Word or Excel version?

No. The tool makes a PDF that prints on standard letter paper, turned sideways so all 31 days fit.