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Symptom Response Kit Prescription Form

SRK is a temporary or short term solution only.

• The SRK are MD/NP orders to be implemented by a nurse (RN, RPN) when symptoms require urgent intervention to manage acute symptoms and facilitate a comfortable death at home.
• The MRP/NP is to be notified as soon as possible regarding changes in condition necessitating the initiation of orders.
• ALL requested medications must be checked off in the form.