EmailMe Form - MEDICATION REMINDERS & CG PROTOCOLS / Reminder EMF

Today's Date *

MM / DD / YYYY

Your Name *

Your Email

2 METHODS FOR A HOME INSTEAD CAREGIVER TO HELP OUT

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Method #1: Directly from the Pill Bottles *

I understand Method #1 = Client takes pills directly from the Pill Bottles (client opens bottles and takes them). I cannot open and give pills from bottle. I can only remind the client to do so.

Method #1: Directly from the Pill Bottles *

As I mentioned above: I CANNOT open the bottles and take pills out. If a client needs help, we can send an RN to place in a pill organizer. Home Instead caregivers CANNOT give pills from a pill bottle

Method #2: From Pill Organizers *

I understand that Method #2 is from Pill Organizers (see below) that are labeled Sunday thru Saturday (or 1 per day of the month) and each rectangular box will say: Morning, Noon, Evening and Bedtime. I can give meds from these trays

Method #2: From Pill Organizers *

I understand that Home Instead caregivers can open the box that corresponds to the day and time and give those pills to a client. Caregivers CANNOT place the pills from the pill bottle into the organizer.

NOT ALLOWED*************************

You cannot put pills in a pill organizer *

I understand that only a registered nurse (RN) or LPN can take medications out of a pill bottle and put in a pill organizer (see image below). I am not a registered nurse or LPN and so I cannot do so.

You cannot administer “finger sticks” to measure blood sugar (see image below) *

I understand that I cannot cannot administer “finger sticks” to measure blood sugar

You cannot touch insulin, measure insulin, you cannot inject insulin (or anything) (see image below) *

I understand that I cannot touch insulin, measure insulin, or inject insulin (or anything)

PERMISSIBLE ACTIVITIES*************************

You can assist a Patient in reading Patient name, medication, route, dosage *

I understand I can assist a Patient in reading Patient name, medication, route, dosage

You can assist a Patient take a Pill Organizer and choose the right time and day *

I understand I can assist a Patient take a Pill Organizer and choose the right time and day. I can then assist the client to open and take the medications for the correct day and time

OTHER*************************

CLIENT REFUSES TO TAKE MEDICATIONS *

CLIENT REFUSES TO TAKE MEDICATIONS. If my client(s) refuse to take their medication, I must *

Questions or doubts *

I understand that these rules are made for my protection as per NYS laws and failure to understand and execute them can result in immediate termination and so I will call agency with any questions

Signature *

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