Medication Receipt, Transfer and Disposition Form Florida (63M, F.A.C.)

The mobile form includes fields to document items such as youth's name and date of birth, facility/ program name, medication transfer receipt, chain of custody for medication and chain of custody for medication signature of the person receiving medications. Once the mobile app is filled out a secure PDF is generated. The PDF is easy to share, and a copy is stored in your account for your transportation and receiving records. You can also use the App Builder to personalize and customize this mobile form. Please complete this app when a youth is discharged from a facility or transported to another facility. Medications must be in the original pharmacy container. The Youth's Name, Physician, Medication Name and Dosage must be legible on the label. There can be no changes written on the label. Any medication brought into the facility that is not in the original container cannot be accepted. The app is also for the purpose of release for medications brought from home, the user understands that these medications are not in a child-proof, safety container, and agree to accept these medications without a child-proof, safety container. They understand that if you do not agree to accept these medications without a child-proof, safety container, the DJJ representative is not authorized to provide any medications. In consideration of agreeing to accept these medications in a non-child-proof, non-safety container, they assume full and complete responsibility for the use and storage of medications from the signed date forward. This app is specific to the Laws of the State of Florida.