* = Required Information
Identification
Conditions
If both of the conditions below are applicable, complete the Identification of Target Symptoms section:
A Helping Hand Senior Care Services LLC is assigned responsibility for medication administration for this individual.
This person is prescribed one or more psychotropic medications.
Identification of Target Symptoms
Symptom Monitoring
If the prescriber of the psychotropic medication(s) requires A Helping Hand Senior Care Services LLC to document the methods to monitor and measure changes in the target symptoms, complete the table below and Distribution Frequency of Monitoring Reviews section:
N/A
Distribution Frequency of Monitoring Reviews
Annually Semi-annually
Quartely Other
N/A


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