Shared Living - Medication Binder

Table of Contents - Explained

  1. Emergency Fact Sheet
  1. Color photograph of the individual-recent
  2. Written description of the individual
  3. Date of birth
  4. Allergies
  5. Preferred nicknames
  6. Guardian-name/ address/ phone number
  7. Next of kin-name/ address/ phone number
  1. Emergency Contact Telephone Numbers

Servicenet and state numbers: (program director, vp, emergency services, dds service coordinator, nurse consultant, poison control, local emergency number/ 911)

Personal contacts: (next of kin, legal guardian, primary care provider, psychiatrist, dentist, other specialists)

  1. Current Medical Doctors Orders

Servicenet uses a specific format for all healthcare provider orders; the template is stored in eHana where you will enter the changes as the MD makes them. ALL MEDICAL ORDERS NEED TO BE WRITTEN IN ON THIS SHEET AT EVERY INDIVIDUAL’s doctor visits.

  1. Psychiatrist Orders

See section C, above

  1. All medical orders for the last 3 months

Medical/psych/dental/vision, etc.

  1. Medication Administration Record

(The pharmacy generally sends out a medication administration sheet with the meds that is used to document the administration of all meds. It needs to be signed of by the med administrator in the correct grid for the right med, dose and date.) These must be kept in the med binder for auditing purposes, then given to the Program Director for confidential filing.

  1. Medication Information Sheets

Every medication that the individual receives must have a corresponding medication sheet that describes the medication, its indication and side effects. The medication information sheet (aka M.I.S) is typically sent by the psychiatrist, however individual ones can also be downloaded and printed off of a reliable website, such as or

  1. Pharmacy receipts

Organized and in order for the previous 90 days

  1. D.D.S. common Ailments brochure
  1. Unique needs of the individual

e.g. seizure information and care protocol, special dietary considerations, blood glucose monitoring/indications/directions, weight or vital sign monitoring, etc.

Medication Administration:

All medications must be stored in a locked cabinet. If the individual you serve self administers his/her own meds, the expectation is that you will observe the self administration, and assure that the individual correctly documents on the medication administration record (MAR) that they did take the meds. If the individual requires partial or complete assistance with medication administration, you will need to sign off on the MAR to document that the medication was given. It is also the expectation that you will work with the individual to assure that refills of medication are obtained in a timely manner, and that prescriptions do not run out. Your Program Director will come out to your home and review the medication binder and cabinet on a monthly basis to answer any questions and work with you to assure that you are using good practice. An RN will also perform a quarterly review.

All individuals in placement services must have the following entered and monitored on eHana and the Operations Portal:

  1. Annual physical exam, including an annual hearing screen
  2. If under the care of a psychiatrist, quarterly visits
  3. Dental every 6 months
  4. Vision every 1-2 years.

The Program Director will accompany the provider and person served to all annual physicals and psych appointments. Information is to be entered into eHana by the provider and verified by the Program Director. Audits will be done monthly by the Program Director and quarterly by the RN consultant.