Instructions:

1. Complete the audit prior to Site Champion Training.
2. Click here to download a PDF you can use to print and create as a draft. The draft 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 patients in your organization taking Carbidopa/Levodopa over a 2-day time period.
4. Complete this survey for each patient, 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.