Personal Medication Device (PMD) Termination Form

Description

An example form that keeps track of an automated medication dispenser (“PMD”) when the patient no longer needs it, i.e., is terminated from the PMD program.

Audience

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 is important for tracking technologies that are installed in a patient’s home and need to be returned for refurbishing and reuse by another patient.

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