Medication Assessment

Client Information

Date of Assessment *

Reason for Assessment

Name of Assessor

Assessors Email *

Client Name

Date of Birth

Allergies/Advert Events

Is the client on blood thinners?

YesNoUnsure

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Are there any alerts in place?

YesNoN/A

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Are there any communication devices/interpreters required?

YesNoOther

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Does the client live alone?

YesNo

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General Practitioner Information

Practice Name

Doctors Name

GP Medication Authority attached?

YesNoN/AOther

GP Medication Authority

Browse

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Chemist information

Name of Chemist

Phone number

Address

Street address

Suburb

State

Postcode

Vital Signs

Heart Rate

RegularIrregular

Blood Pressure Sitting

Blood Pressure Standing

Respiratory Rate

Oxygen Saturation

Temperature

Vision

Does the client need to wear glasses?

YesNoOther

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Did the client wear their glasses during the visit?

YesNoOther

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Does the client have a vision impairment that can limit their ability to self-administer medications?

YesNoOther

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Oral Health

What type of teeth does the client have?

Natural teethDenturesOther

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Does the client have any swallowing difficulties?

YesNoOther

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Cognition

Is the client orientated to time and place?

YesNoN/AOther

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Is there any cognitive impairment to be considered?

YesNoOther

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Medication

Does the client currently take any medication?

YesNo

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Is polypharmacy a potential issue?

YesNo

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Does the client take more than 5 medications?

YesNoOther

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Is the client using any medication aids?

YesNoN/A

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Does the client have any loose medications in the original box?

YesNoN/AOther

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Does the client understand what their medication is for?

YesNoOtherN/A

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Are there any issues with the clients motor skills?

YesNoOther

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Is the client able to open the items needed to dispense their medication?

YesNoOtherN/A

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Is the client able to distinguish their medication?

YesNoN/AOther

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Is the client aware of what to do if they miss a dose?

YesNoN/AOther

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Is the client aware of what to do if they take the wrong dose?

YesNoOtherN/A

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Is the client aware of what to do if they overdose?

YesNoOtherN/A

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Does the client receive their medication from more than 1 pharmacy?

YesNoOtherN/A

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Who delivers the medication from the pharmacy to the client?

ClientFamilyOther

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Is the client on any non-oral medication?

YesNoOtherN/A

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Is the client able to administer their own non-oral medication?

YesNoOtherN/A

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Is the client currently using any topical creams?

YesNoOtherN/A

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Can the client manage the application of their topical cream?

YesNoOtherN/A

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Is the client currently using an inhaler?

YesNoOtherN/A

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Can the client manager their inhaler?

YesNoOtherN/A

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Is the client currently using any eye drops?

YesNoOtherN/A

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Can the client manage their eye drops on their own?

YesNoOtherN/A

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Is the client a diabetic?

YesNoOtherN/A

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Is insulin managed by the client?

YesNoOtherN/A

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Is the client on a transdermal patch?

YesNoOtherN/A

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Who is assisting the client with their transdermal patch?

FamilySensible Care (Nursing Team)Other

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Does the client remove and dispose of any stopped or expired medications?

YesNoOtherN/A

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How many times a day is the client currently taking medication? Please specify.

Does the client need a medication lock box?

YesNoOther

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Recommendations

Final Draft of the Assessment

Yes

Care Managers Email:Care Managers email address is their first name @sensiblecare.com.au (eg. mary@sensiblecare.com.au)

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