Drug Disposal Sheet DHS 4590 6/09

|Drug Disposal Sheet |[pic] |

| |Stabilization and Crisis Unit |

House name: Reason for disposalMethod of disposalSignaturesDate

(mm/dd/yyyy)Client nameDrug description:

Why taken:DoseAmountDiscontinuedRecalledOutdatedUnusedOther: Disp. SolutionCat litterCoffee GroundsOther: DestroyerWitness

(RN if narcotic)

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