Form LIC 622A, Medication Administration Record (MAR) - also referred to as a MAR template - is a document used to record and administer medications prescribed to a child. This specific form is suitable to record non-psychotropic medications only. It is considered a legal record of the medications administered to a child by the health care professional.
The LIC 622A Form is a state-specific document issued and used by the California Department of Social Services Community Care Licensing Division. The most recent version of the form was released by the department in June 2017. You can find and download the up-to-date form through the link below.