MEDICATION DISPOSAL SHEET
MEDICATION DISPOSAL SHEET
CLIENT NAME: DOB: AVATAR ID:
Medication - Name
and Strength |Count |Method of Disposal |Reason for Disposal |DCFS Staff
Signature |DCFS Staff Witness Signature |Disposed of by (Signature) |Date Disposed | | | | Parent
Pharmacy
Law Enforcement
DFS Nurse Case
Management Unit
Other (specify) | Expired
Discontinued
Unused
| | | | | | | | Parent
Pharmacy
Law Enforcement
DFS Nurse Case
Management Unit
Other (specify) | Expired
Discontinued
Unused
| | | | | | | | Parent
Pharmacy
Law Enforcement
DFS Nurse Case
Management Unit
Other (specify) | Expired
Discontinued
Unused
| | | | | | | | Parent
Pharmacy
Law Enforcement
DFS Nurse Case
Management Unit
Other (specify) | Expired
Discontinued
Unused
| | | | | | | | Parent
Pharmacy
Law Enforcement
DFS Nurse Case
Management Unit
Other (specify) | Expired
Discontinued
Unused
| | | | | |
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