Individual Narcotic Count Sheet .us



|Client name: |      |Medication name: |      |

|Date of physician’s order: |      |Dosage: |      |

|Physician’s name: |      |Method of administration: |      |

| | |Rx number: |      |

| | | | |

|[pic] | |

|Office of Developmental Disabilities | |

|Stabilization and Crisis Unit |Individual Narcotic Count Sheet |

DateTimeAmount

on-handAmount receivedAmount givenAmount remainingSignatureWitness signature

Document any discrepancies on the next available line and complete a GER Medication Error Report.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download