ASC Medication Administration Record (MAR) — FAQ
The MAR is an ASC nursing documentation tool for recording medication administration. It is only available in the surgical case. Each MAR flowsheet medication links to a MAR order entered by a provider or delegate. Providers with sign-off permissions can later sign it in the chart or Clinical Inbox. All MAR orders and administrations are recorded in the surgical case summary.
How do I get started on the MAR?
Start by configuring medication preference cards. The MAR works best when standing or protocol nursing medication orders are pre-configured with complete sigs and instructions. When imported into the patient chart, these orders typically require only a quick review and minor edits before activation for MAR administration.
Additional medications can also be entered ad hoc to address needs not covered by standing orders.
Why are procedure medications going away?
Starting in July 2026, medications will no longer be documented as procedure medications within the Pre or Post procedure stages of the surgical case. Instead, all nurse-administered medications must be ordered and documented in the Medication Administration Record (MAR) within the appropriate stage of the surgical case. Medications administered directly by providers should continue to be documented in the procedure documentation, operative note, or anesthesia record, as appropriate.
The Intra-Procedure Medications section will remain available, but it is not intended to replace the MAR for documenting nurse-administered medications. This section is optional and may be used to document in-field prepared medications, nurse-administered oxygen, and titrated sedation medications when appropriate.
What permissions are required for the MAR?
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Clinicals: MAR Order Sign-Off — Allows ASCs to designate who can directly order & sign off on nurse-entered medication orders. This permission is included in the Supervising Physician Clinicals role and is available as an add-on if needed.
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Clinicals: MAR Order Configuration Admin — Allows ASCs to control who can add, edit, or delete medications and associated preference cards. This permission is included in the Clinicals Admin role and is available as an add-on if needed.
Additional MAR requirements
The MAR also requires the following existing permissions and configurations:
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Clinicals: Edit Chart permission
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All MAR order sign-off providers must be listed in the Billing Providers admin page (Settings
> Billing > Providers) -
Clinical team members who enter orders on behalf of a MAR order sign-off provider must be listed as delegates in the Order Delegation admin table
How do I search for MAR orders or medication preference cards?
In the Physician stage of the surgical case, click the add icon 
next to Diagnosis & Orders. You can access the MAR Orders section and preference cards on the right side of the Diagnosis & Orders cart.
Unlike prescribing, MAR orders do not require a specific dose form. This makes ordering simpler and lets users find medications with shorter search terms.
Examples of MAR orders
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PO: Acetaminophen Oral
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IV: Fentanyl IV
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IM: Toradol IM
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IV Fluids: Sodium Chloride 0.9% IV or Lactated Ringers IV
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Order searching is available using brand or generic medication names
Can I add other orders, such as labs, to my preference cards if they are not for MAR administration?
Not currently. All other order types including prescriptions are managed using order sets.
Can I add my MAR orders during prep before the patient checks in?
Yes, you can add MAR orders while the surgical case is in Draft status. However, you cannot activate them until the patient checks in to ensure the orders are reviewed and confirmed based on the patient’s pre-op presentation.
How can I optimize MAR medication ordering to make it as fast as possible?
Use medication preference cards to streamline the entry of standing MAR orders. Pre-configure all standing order required fields: procedure stage, dose amount, dose unit, frequency, duration type, duration amount, duration unit, and infusion rate for fluids. Use order notes to clarify indications, preferred therapy sequence, and when additional action is required (e.g. notify the ordering provider).
In the Diagnosis & Orders cart, search for and select the appropriate card. After importing, update the sig as needed and delete any irrelevant orders.
Can I adjust my preference card before adding the orders to the Drafts section like I do for order sets?
Not currently. Preference cards are added directly to the Drafts section of the surgical case. Once added, you can edit or delete orders before activating them by entering or signing the orders in Drafts. At the moment, you cannot edit the preference card during the workflow.
However, before adding the preference card to Drafts, you can edit the preference card in the MAR Order Configuration admin page on the Procedure MAR Orders tab. Click the expand icon 
next to the order set card followed by the pencil icon 
to make edits.
I activated a medication order by mistake. What should I do?
Once a medication order is entered or signed, it becomes active on the MAR for nursing administration.
To correct an order entered in error, in the Physician stage, under Medication Orders in the Active section, click Discontinue next to the medication. The discontinued order then appears on the MAR to show that it should not be given. As a best practice, directly notify the nurse caring for the patient.
Can a different doctor sign orders on behalf of another?
Yes. Providers with the MAR Order Sign-off permission can choose which delegated orders to sign off on, either in the patient chart or from the Clinical Inbox.
How can I order a TKO or KVO IV fluid drip?
If a patient does not require fluid replacement, order an IV rate to reflect a standard To Keep Open (TKO) or Keep Vein Open (KVO) order per your internal protocols.
How do I order an IV bolus for fluids to be given with the clamp wide open to gravity?
If a patient needs rapid fluid replacement, use a rate of 999 and add an IV Bolus order note.
Can I document IV details within the MAR?
Yes. When documenting administration in the MAR flowsheet, you can record the IV site, indicate whether a diluent was used (including the type), and add notes to capture additional details as needed.
Can I order and administer titrated medications using the MAR?
Titration orders are flexible medication orders that allow dose and frequency adjustments to achieve a specific clinical goal, such as sedation.
The MAR is designed to document nurse-administered medications, not to support anesthesia workflows. It currently supports orders with fixed doses, frequencies, and durations, along with PRN orders that include guidance on dosing thresholds.
How do I view MAR orders and administrations after the surgical case closes?
You can view the surgical case encounter summary for details and/or amend the encounter.
Can I use the MAR in the clinic?
The MAR is currently available only within the surgical case encounter layout. We may expand the MAR to clinics in the future.
If you’re interested, please submit an idea in the Success Community and include details on how it would improve your athenaClinicals experience.