Controlled Drug Administration Record Assisted Living
Updated August 2023
Designed for use in an Assisted Living community to record the administration of controlled drugs per individual resident and the:
• | Name of drug, strength, dose, and form as well as directions for use of a controlled drug |
• | Dispensing pharmacy identification; receipt of drug |
• | Where stored |
• | Route of administration |
• | Recording of 30 doses |
• | Appropriate signatures |
• | Disposition of unused drug |
Size: 8 1/2" x 11"
Paper: white paper, black ink,
Punching: 5-hole punched top and side
Packaging: padded in 100.