Instructions:

1. Complete the audit prior to Site Champion Training.
2. Click here to download a PDF you can use to print and use as a worksheet. The worksheet may be helpful to use because once you begin the online survey you will not be able to go back and make edits.
3. Review Medication administration records for all Parkinson's clients/residents taking Carbidopa/Levodopa formulations, such as carbidopa/levodopa immediate or controlled-release or Rytary © (carbidopa/levodopa extended-release capsules) over a 2-day time period.
4. Complete this survey for each client/resident, using an identifier you can easily recognize without revealing personal health information. For example, many people use the room number of the patient to keep track of which medication audits have been conducted.
5. If a dose was not given, please document the reason in the notes section at the end of each page (i.e. patient refused, patient out of the building, etc.)
6. The notes section may also be used for any personal observations you may have regarding individual medication administration.