Form LIC 622A, Medication Administration Record (MAR), 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 Community Care Licensing Division, a division of the California Department of Social Services (CDSS). The most recent version of the form was released by the department on June 1, 2017. You can find and download the up-to-date form through the link below.
Pressing the PRINT button will only print the current page. Download the document to your desktop, tablet or smartphone to be able to print it out in full.