The Departments of Public Health, Mental Health and Developmental Services have compiled all existing Medication Administration Program advisories and policies into one comprehensive document, the MAP Policy Manual. The policies in this Manual, some of which are revisions of existing policies, supersede all other policies on these topics previously issued by the Departments.

The MAP Policy Manual is intended to provide service providers, trainers, staff and other interested parties with a single, topically organized source for MAP policies. Each site registered with DPH must maintain a copy of this policy manual as part of the required reference materials for MAP Certified staff.

Documents

• Medication Administration Program (MAP) Policy Manual  file size 2MB

Forms

The forms below can be filled in using your computer and then printed out. Be sure to delete any previously entered data before starting a new form.

• Section 2 MAP Recertification Competency Evaluation Form 
• Section 7 Observation Tool For Self-Administration 
• Section 7 Self-administration Support Plan 
• Section 7 Self-Administration Teaching Plan 
• Section 8 Oxygen Therapy Training Guidelines 
• Section 9 MOR Medication Occurrence Report 
• Section 10 Controlled Substance Disposal Record Form 
• Section 14 Competency Evaluation Tool for Epinephine via Auto Injector 
• Section 14 Competency Evaluation Tool for G or J Tube Continuous Feeding and Discontinuation of Feeding 
• Section 14 Competency Evaluation Tool for G or J Tube Water Flushes 
• Section 14 Competency Evaluation Tool for Gastrostomy Tube Bolus Feeding 
• Section 14 Competency Evaluation Tool G or J Tube Medication Administration 
• Section 14 Gastrostomy or Jejunostomy Registration Form MA DDS 
• Section 16 Admission to Hospice Check Off List 
• Section 16 Hospice Clinical Progress Note 
• Section 16 Hospice Contact Listing 
• Section 16 Hospice Health Care Provider Order Form 
• Section 16 Hospice Intake Addendum 
• Section 16 Hospice Medication Sheet 
• Section 16 Individualized Hospice PRN Medication Observation Protocol Form 
• Section 16 Pain Review for Individual with Dementia or are Non-verbal 
• Section 16 Reference Sheet for Calling a Hospice Nurse 
• Section 16 Sealed Hospice Emergency Starter Kit Count Sheet 

Additional Printouts

• Section 16 Printout_Individual's Hospice Notebook Section Tabs 
• Section 16 Printout_Medication Sheet Location in Hospice Notebook 

 

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This information is provided by the Drug Control Program within the Department of Public Health.