PRN MEDICATION CHARTING CHECKLIST
Companion prompts for an approved medication record. Complete only from actual care and the active order.

PATIENT AND ORDER
Patient identifiers:
Order reference / prescriber / active status:
Medicine, strength/formulation, dose and route:
Indication and criteria for use:
Minimum interval; applicable maximum and time window:
Selection instructions / holds / precautions:
Last administration and relevant total in the specified window:
Source of medication history / unresolved discrepancy:

ASSESSMENT
Assessment date and time:
Symptoms or signs; patient report versus observation:
Relevant checks, preferences and actions:

WHAT HAPPENED
Given / not needed / declined / withheld / unavailable / clarification pending:
Actual medicine, dose, route and administration time (if given):
Administrator / eMAR entry:
If not given: reason and action taken:

REASSESSMENT AND FOLLOW-UP
Planned reassessment time and responsible clinician:
Actual reassessment time and findings:
Effect / adverse response / patient report:
Contact made, time and reason:
Actual response or new authorized order:
Unfinished task / accepted owner / next checkpoint:

ENTRY CHECK
Event time and entry time distinguished:
Narrative checked against eMAR:
Author and authentication:
Correction reference and history, if applicable: