Long Term Care Pharmacy 24/7: 

(612) 259-8275

Important information about COVID-19 is available.

Medication Administration Record Request

Please fill out the form below and we will create a Medication Administration Record (MAR) for the given resident.  If you use an e-MAR, please contact us directly at 612-259-8275 to set up proper integration.

  • All fields are required except for RX Number and Insurance Information.
  • If you are completing this form on behalf of a client, please provide your name and contact information.
  • This field is for validation purposes and should be left unchanged.