1. RECORDS OF DANGEROUS DRUGS DISPENSED FOR
IN –PATIENTS IN HOSPITAL AND SIMILAR INSTITUTIONS
GENERIC
Name of Dangerous Drug(s) Dispensing Pharmacist Date
Amount Receiving Nurse
Amount of Carried Over
FULL
NAME OF
PATIENT(S)
BED
NO.
TIME
OF
ADM.
FULL NAME
OF
PRESCRIBING
PHYSICIAN(S)
NARCOTIC
LIC NO.
DDB
PRESCRIPTION
FORM Serial
No.
SIGNITURE
ADMINISTERING
NURSE