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When possible, the surveyor will observe medication administration to verify that staff administers medications using the proper technique and that medications are administered as ordered. If possible, the surveyor will observe at least 10 medications being administered, by three or more different staff, by three or more different routes, at three or more medication times. Date and Time Name of Staff Person/Title Observed Client Name Drug, Dosage, Route Notes Prescriber s Order? Yes or N.

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