MEDICATION DISPOSAL SHEET - Nevada



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

| | | |      | |

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

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

Google Online Preview   Download