Individual Resident Controlled Substance Records are a tool to help facilities and caregivers track the administration, inventory, and if needed, disposal of controlled drugs and substances prescribed for a specific patient.
Common data included on this type of form includes medication name, resident name, prescribing physician, dosage, pharmacist name, amount ordered, quantity remaining, nurse signature line, witness signature line, disposition of doses remaining (check boxes for “doses transferred to approved waste receptacle”, “doses flushed”, “doses incinerated”, “doses mixed with cat litter/coffee grounds”), time/date dose administrated, and more can be added based on your needs.
Many pharmacies like to customize and deliver these forms during medication delivery not only to promote their branding but so that the phone # & fax # of the pharmacy are visible on this important patient care document.
- Freight additional using most economical carrier
- 1,500 forms per case
- Production time estimated at 10 days on repeat orders
- PAS manufactures Individual Controlled Substance Record Forms to help Long Term Care (LTC), Assisted Living, Managed Care, and other facilities track the inventory, administration, waste and disposal of controlled substances.
- 8.5" x 11" size
- Price per 1,000
- Packaged 1,500 per carton
- Portrait or Landscape Orientation Available
- Compatible with all major laser printers
- Printing available in up to 6 total colors
- White 28 leger paper but other weights available (price will vary)
- 5 and 10 hole punch available to fit common facility charts/binders
- Pricing includes standard 5 hole punch
- For 10 Hole Punch add $85 flat fee per order
- Unlimited potential for customization to suit the unique needs of facilities or pharmacies providing the record
- Differentiate yourself from your competition (most of whom use stock forms) by adding your branding and unique color scheme
- If you’re looking to copy an existing design you can submit a scan or image of your current form here.
- 8.5" x 11" Laser Cut Sheet
- 1,500 per case
- Priced per 1,000
- Up to 6 colors total
- Pricing includes 5 hole punch