Form 3092 "Medication Administration Record" - Texas

What Is Form 3092?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 3092 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

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Download Form 3092 "Medication Administration Record" - Texas

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Form 3092
September 2020-E
Medication Administration Record
Name:
Month:
Year:
Medication/ dosage/
frequency/
Time
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
route
Initial
Signature
Known allergies or adverse reactions:
Form 3092
September 2020-E
Medication Administration Record
Name:
Month:
Year:
Medication/ dosage/
frequency/
Time
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
route
Initial
Signature
Known allergies or adverse reactions:
Form 3092
Page 2 / 09-2020-E
Date/Time
Medication/Dosage
Reason
Results
Hour/Initials
Vital signs or other tracking per physician or team request:
Date:
Date:
Date:
Date:
Date:
Date:
Weight:
Blood Pressure:
Temperature:
Pulse:
Other:
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