Medication/Treatment Discrepancy Form
The following must be completed any time a medication or treatment discrepancy is discovered:

1. Call the nurse immediately
2. Document the discrepancy on the MAR and Health Progress Notes
3. Complete this form

After receiving this form, administrative staff will assign retrainings as needed.
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  • Check all that apply.
  • Please provide a clear explanation of the discrepancy.
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  • For example, did you contact your supervisor? Did you contact the nurse? Be sure to include ALL instructions from the nurse or physician as well as any follow up needed. This must also be documented in Health Progress Notes and communicated with all other program staff.
  • Please include the full name of the staff responsible. This should be any staff present at the time of the discrepancy.