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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

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

Forms

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

MAP Advisories and Resources

MAP Advisories and Resources

Archived MAP Policy

Open PDF file, 1.36 MB,  MAP Policy Manual - 11.17.25 (PDF) (English, PDF 1.36 MB)
Open DOCX file, 574.17 KB,  MAP Policy Manual - 11.17.25 (DOCX) (English, DOCX 574.17 KB)
Open PDF file, 3.07 MB,  MAP Policy Manual - 4.15.25 (PDF) (English, PDF 3.07 MB)
Open DOCX file, 623.5 KB,  MAP Policy Manual - 4.15.25 (DOCX) (English, DOCX 623.5 KB)
Open PDF file, 4.74 MB,  MAP Policy Manual - 12.2.24 (PDF) (English, PDF 4.74 MB)
Open DOCX file, 629.66 KB,  MAP Policy Manual - 12.2.24 (DOCX) (English, DOCX 629.66 KB)
Open PDF file, 2.16 MB,  MAP Policy Manual – 11.15.2023 (PDF) (English, PDF 2.16 MB)
Open DOCX file, 706.27 KB,  MAP Policy Manual – 11.15.2023 (DOCX) (English, DOCX 706.27 KB)
Open PDF file, 2.7 MB,  MAP Policy Manual - 6.28.2023 (PDF) (English, PDF 2.7 MB)
Open DOCX file, 1.04 MB,  MAP Policy Manual - 6.28.2023 (DOCX) (English, DOCX 1.04 MB)
Open PDF file, 2.01 MB,  MAP Policy Manual - 2015 (PDF) (English, PDF 2.01 MB)
Open DOCX file, 723.07 KB,  MAP Policy Manual - 2015 (DOCX) (English, DOCX 723.07 KB)

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