After discharge from the hospital, a patient may continue taking some medications at home, but not perhaps all of them. Therefore, it is extremely important to compare the discharge medication orders with the nursing medication administration record (MAR) to check for any discrepancies. If a medication the patient has been receiving in the hospital is not in the discharge orders, and there is no adequate documentation indicating why that medication has been omitted, then a nurse or pharmacist should contact the patient’s physician to verify whether or not the patient should discontinue use of the medication.