Personal Medication Device (PMD) Activation Form


An example form that keeps track of an automated medication dispenser (“PMD”) upon installation in a patient’s home. The example also gathers information about how to contact the caregiver(s), medication loading, dose reminding schedules, and patient messaging—all of which will be used to program the machine.


Program designers and managers, technology managers, and field personnel (e.g., home health nurses or technology installers that visit a patient’s home)

Helpful Tips

A form such as this collects and communicates information about technology interventions in a structured way, ensuring comprehensive and consistent technology use and programming.

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