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MAP Policy Manual

Each MAP site registered with DPH must maintain a copy of this policy manual as part of the required reference materials for MAP certified staff.
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Policy Manual

MAP Policy Manual Final, Open DOCX file, 575.32 KB (English, DOCX 575.32 KB)
MAP Policy Manual Final, Open PDF file, 1.53 MB (English, PDF 1.53 MB)
Guide to the MAP Policy Manual, Open DOCX file, 33.56 KB (English, DOCX 33.56 KB)

Forms

Section 02 Annual Observation of Medication Administration Form Sample 3-1-24, Open DOCX file, 71.61 KB (English, DOCX 71.61 KB)
Section 05 MAP Recertification Competency Evaluation Form Required 11-17-25, Open DOCX file, 74.48 KB (English, DOCX 74.48 KB)
Section 05 MAP Recertification Evaluation Guide 11-17-25, Open DOCX file, 67.5 KB (English, DOCX 67.5 KB)
Section 08 Medication Reconciliation Discharge HCP Orders Checklist Sample, Open DOCX file, 32.6 KB (English, DOCX 32.6 KB)
Section 10 OTC Dietary Supplement Without Pharm Label Training Template Sample, Open DOCX file, 16.72 KB (English, DOCX 16.72 KB)
Section 15 Medication Disposal Record Form Required, Open DOCX file, 37.58 KB (English, DOCX 37.58 KB)
Section 17 Medication Occurrence Report Form, Open DOCX file, 83.15 KB (English, DOCX 83.15 KB)
Section 18 Blood Glucose Monitoring Training Competency Form General Knowledge Optional, Open DOCX file, 68.51 KB (English, DOCX 68.51 KB)
Section 18 Blood Glucose Monitoring Training Competency Form Individual Specific Optional, Open DOCX file, 31.13 KB (English, DOCX 31.13 KB)
Section 18 Vital Signs Training Competency Eval Sample, Open DOCX file, 15.68 KB (English, DOCX 15.68 KB)
Section 19 Clozapine Therapy Training Competency Eval-Required , Open DOCX file, 75.12 KB (English, DOCX 75.12 KB)
Section 19 Epinephrine via Auto Injector General Knowledge Required, Open DOCX file, 35.35 KB (English, DOCX 35.35 KB)
Section 19 Epinephrine via Auto Injector Individual Specific Required, Open DOCX file, 32.89 KB (English, DOCX 32.89 KB)
Section 19 Epinephrine via Auto Injector Return Demonstration Required, Open DOCX file, 21.49 KB (English, DOCX 21.49 KB)
Section 19 G-J Tube Competency Eval Completion of Feeding Return Demonstration Optional, Open DOCX file, 71.44 KB (English, DOCX 71.44 KB)
Section 19 G-J Tube Competency Eval Bolus Feeding Return Demonstration Optional, Open DOCX file, 71.27 KB (English, DOCX 71.27 KB)
Section 19 G-J Tube Competency Eval Continuous Feeding Return Demonstration Optional, Open DOCX file, 72.17 KB (English, DOCX 72.17 KB)
Section 19 G-J Tube Competency Eval Medication Administration Return Demonstration Required, Open DOCX file, 19.65 KB (English, DOCX 19.65 KB)
Section 19 G-J Tube Competency Eval Water Flush Return Demonstration Required, Open DOCX file, 22.33 KB (English, DOCX 22.33 KB)
Section 19 G-J Tube Management Form Required, Open DOCX file, 12.07 KB (English, DOCX 12.07 KB)
Section 19 G-J Tube Medication Administration General Knowledge Competency Eval Required, Open DOCX file, 74.46 KB (English, DOCX 74.46 KB)
Section 19 G-J Tube Medication Administration Individual Specific Competency Eval Required, Open DOCX file, 74.87 KB (English, DOCX 74.87 KB)
Section 19 Insulin Administration via Insulin Pen by MAP Certified Staff Training Competency Evaluation Tool for General Knowledge, Open DOCX file, 38.18 KB (English, DOCX 38.18 KB)
Insulin Administration via Insulin Pen by MAP Certified Staff Training Competency Evaluation Tool for ‘Individual-Specific’, Open DOCX file, 40.84 KB (English, DOCX 40.84 KB)
Section 19 Insulin Administration via Insulin Pen by MAP Certified Staff Training Return-Demonstration Competency Evaluation Tool for ‘Initial’, Open DOCX file, 35.71 KB (English, DOCX 35.71 KB)
Section 19 Insulin Administration via Insulin Pen by MAP Certified Staff Training and Demonstration Competency Evaluation Tool, Open DOCX file, 35.54 KB (English, DOCX 35.54 KB)
Section 19 HCP Orders Telephone Telehealth Warfarin Sodium Optional, Open DOCX file, 19.24 KB (English, DOCX 19.24 KB)
Section 19 HCP Orders Warfarin Sodium Optional, Open DOCX file, 9.73 KB (English, DOCX 9.73 KB)
Section 19 Narrative Notes Optional, Open DOCX file, 24.69 KB (English, DOCX 24.69 KB)
Section 19 Oxygen Therapy Protocol Optional, Open DOCX file, 66.16 KB (English, DOCX 66.16 KB)
Section 19 Oxygen Therapy Training General Knowledge Competency Eval Optional, Open DOCX file, 71.1 KB (English, DOCX 71.1 KB)
Section 19 Oxygen Therapy Training Individual Specific Competency Eval Optional, Open DOCX file, 30.83 KB (English, DOCX 30.83 KB)
Section 19 Warfarin Sodium Chronological Event Sheet Optional, Open DOCX file, 66.16 KB (English, DOCX 66.16 KB)
Section 19 Warfarin Sodium Competency Eval Tool General Knowledge Required, Open DOCX file, 34.08 KB (English, DOCX 34.08 KB)
Section 19 Warfarin Sodium Competency Eval Tool Individual Specific Warfarin Required, Open DOCX file, 32.96 KB (English, DOCX 32.96 KB)
Section 19 Warfarin Sodium Medication Sheet Alternating Doses Sample, Open DOCX file, 27.62 KB (English, DOCX 27.62 KB)
Section 19 Warfarin Sodium Medication Sheet Sample, Open DOCX file, 22.98 KB (English, DOCX 22.98 KB)
Section 19 Warfarin Sodium Therapy Protocol Sample, Open DOCX file, 11.07 KB (English, DOCX 11.07 KB)
Section 20 Learning to Self-Administer Medication Teaching Support Plan Sample, Open DOCX file, 80.55 KB (English, DOCX 80.55 KB)
Section 20 Observation Tool for Self-Medication Administration Skills Sample, Open DOCX file, 77.76 KB (English, DOCX 77.76 KB)
Section 22 Hospice Admission to Hospices Services Care Checklist Sample, Open DOCX file, 66.23 KB (English, DOCX 66.23 KB)
Section 22 Hospice Contacts List Sample, Open DOCX file, 64.85 KB (English, DOCX 64.85 KB)
Section 22 Hospice Intake Addendum Form Sample, Open DOCX file, 80.75 KB (English, DOCX 80.75 KB)
Section 22 Hospice Notebook Cover Sheet Optional, Open DOCX file, 62.65 KB (English, DOCX 62.65 KB)
Section 22 Hospice Notebook Tabs Optional, Open DOCX file, 63.91 KB (English, DOCX 63.91 KB)
Section 22 Hospice Pain Review for Non-Verbal Individual Form Sample, Open DOCX file, 74.05 KB (English, DOCX 74.05 KB)
Section 22 Hospice Progress Narrative Notes Sample, Open DOCX file, 67.66 KB (English, DOCX 67.66 KB)

MAP Advisories and Resources

MAP Advisories and Resources

Archived MAP Policy

MAP Policy Manual - 11.17.25 (PDF), Open PDF file, 1.36 MB (English, PDF 1.36 MB)
MAP Policy Manual - 11.17.25 (DOCX), Open DOCX file, 631.98 KB (English, DOCX 631.98 KB)
MAP Policy Manual - 4.15.25 (PDF), Open PDF file, 3.07 MB (English, PDF 3.07 MB)
MAP Policy Manual - 4.15.25 (DOCX), Open DOCX file, 623.5 KB (English, DOCX 623.5 KB)
MAP Policy Manual - 12.2.24 (PDF), Open PDF file, 4.74 MB (English, PDF 4.74 MB)
MAP Policy Manual - 12.2.24 (DOCX), Open DOCX file, 629.66 KB (English, DOCX 629.66 KB)
MAP Policy Manual – 11.15.2023 (PDF), Open PDF file, 2.16 MB (English, PDF 2.16 MB)
MAP Policy Manual – 11.15.2023 (DOCX), Open DOCX file, 706.27 KB (English, DOCX 706.27 KB)
MAP Policy Manual - 6.28.2023 (PDF), Open PDF file, 2.7 MB (English, PDF 2.7 MB)
MAP Policy Manual - 6.28.2023 (DOCX), Open DOCX file, 1.04 MB (English, DOCX 1.04 MB)
MAP Policy Manual - 2015 (PDF), Open PDF file, 2.01 MB (English, PDF 2.01 MB)
MAP Policy Manual - 2015 (DOCX), Open DOCX file, 723.07 KB (English, DOCX 723.07 KB)

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