What is the medication administration record form template?
A medication administration record shows, for every resident and every round, what was given, when, by whom — and what wasn't given and why. This template records one round for one resident at a time, so each entry is saved, signed and timestamped as it happens rather than written up later.
Each medicine gets its name and strength, dose and route, time and outcome — given, refused, withheld, not available, asleep, away or self-administered. Any outcome other than given opens a box for the reason and action taken. As-needed (PRN) medicines record the reason and the effect when checked, and controlled drugs require a witness and confirmation that the register was signed. Errors and near misses are flagged, with a prompt to follow the incident procedure.
Each round is saved as a signed PDF in your FileIt vault, building a complete record per resident.
- Best for
- Care homes, supported living services and home care teams administering medicines
- Filled in by
- The staff member giving medicines
- Time to complete
- About 3 minutes per round
- Includes
- Up to four medicines per round, refusal reasons, PRN effect, controlled drug witness, initials and signature
Who uses a medication administration record form?
- Care home medication rounds
- Home care visits where carers administer medicines
- Supported living services with a small number of residents
- Recording PRN pain relief and whether it worked
- Controlled drug administration with a witness
- Evidence of administration for audits and inspections
Questions on this medication administration record form
43 questions over 4 pages · includes signature, conditional questions, multiple pages.
1 Resident & round
- Resident / client name*
- Room or unit
- Date of birth
- Allergies*
- Date*
- Round* Morning · Lunchtime · Teatime · Bedtime · Night · Other time
- Staff member giving medicines*
2 Regular medicines
- Medicine and strength*
- Dose and route*
- Time*
- Outcome* Given · Refused · Withheld (clinical reason) · Not available · Asleep / not woken · Away from home or unit · Self-administered
- Reason and action taken asked only when it applies
- Medicine and strength
- Dose and route
- Time
- Outcome Given · Refused · Withheld (clinical reason) · Not available · Asleep / not woken · Away from home or unit · Self-administered
- Reason and action taken asked only when it applies
- Medicine and strength
- Dose and route
- Time
- Outcome Given · Refused · Withheld (clinical reason) · Not available · Asleep / not woken · Away from home or unit · Self-administered
- Reason and action taken asked only when it applies
- More medicines in this round?
- Medicine and strength asked only when it applies
- Dose and route asked only when it applies
- Time asked only when it applies
- Outcome asked only when it applies Given · Refused · Withheld (clinical reason) · Not available · Asleep / not woken · Away from home or unit · Self-administered
- Reason and action taken asked only when it applies
- Any further medicines this round asked only when it applies
3 As-needed & controlled medicines
- Was an as-needed (PRN) medicine given?*
- PRN medicine, strength and dose* asked only when it applies
- Time given* asked only when it applies
- Time of previous dose, if today asked only when it applies
- Reason given* asked only when it applies
- Effect when checked asked only when it applies
- Was a controlled drug given?*
- Witness name* asked only when it applies
- Controlled drugs register completed and signed by both?* asked only when it applies
4 Notes & sign-off
- Any error, near miss or missing stock?*
- What happened and who was informed?* asked only when it applies
- Observations or concerns
- Initials*
- Signature*
The medication administration record form, page by page
1 Resident & round
Resident name, room and date of birth; allergies (required, with a reminder to check the chart every round); the date and round; and the staff member giving medicines.
2 Regular medicines
Three medicine entries, each with the medicine and strength, dose and route, time and outcome. Any outcome other than Given asks for the reason and action taken. A fourth entry and a box for further medicines appear if there are more in the round.
3 As-needed & controlled medicines
Whether a PRN medicine was given — with its dose, time, previous dose time, the reason and the effect when checked. Whether a controlled drug was given — with the witness's name and confirmation the register was signed by both.
4 Notes & sign-off
Whether there was an error, near miss or missing stock, with details and who was informed and a prompt to follow your incident procedure. Observations or concerns, then the staff member's initials and signature.
Make the template yours
- Add or remove medicine entries to fit your typical rounds
- Change the round names to your medication times
- Add a second-checker signature if your policy requires two staff
- Use the vault folder setting to file rounds by resident
- Add your homely remedies list as another section
- Align outcome codes with the ones your pharmacy chart uses
Tips for a better medication administration record form
- Record immediately after giving each medicine, never in advance
- Always record why a medicine wasn't given, and who you told
- Go back and record the effect of every PRN dose
- Check allergies and the prescription chart every round, even for familiar residents
- This form records administration — the prescription remains the authority on what to give
Every response becomes a PDF in your vault
Each round is saved as a signed PDF in your FileIt vault, and the people you choose are emailed. Errors can be spotted as soon as they're recorded.
Use the Responses table to review a resident's rounds or export to CSV for a medication audit.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Medication administration record form: frequently asked questions
Is this MAR template free?
Yes. It's included in FileIt's Forms app on every account, including the free plan.
Is it one form per resident per round?
Yes. Each submission records one round for one resident, so every entry has its own time and signature.
How are refusals recorded?
Choose Refused (or another outcome) and the form asks for the reason and action taken.
Does it handle controlled drugs?
It records that a controlled drug was given, the witness and that the register was signed. Keep your controlled drugs register as required.
Can I add more medicines?
Yes. Four entries are built in, plus a free-text box; add more entries in the designer if you need them.
Does it replace the prescription chart?
No. It records what was administered against the prescription.