Download Single Drug Disposition Record

Last updated: July 11, 2012
Controlled Substances Single Drug Disposition Record
Date: _________________________________________________________________________
Unit Registrant Name: ___________________________________________________________
Building and Room Location: ______________________________________________________
Location of safe: ________________________________________________________________
Drug Name: _______________________________________ Schedule: _______________ (I-V)
Form (liquid, tablets, patch, etc.): __________________________________________________
Concentration: _________________________________________________________________
Expiration date: ________________________________________________________________
Dilution or combination (mg/ml): __________________________________________________
Total initial volume: _____________________________________________________________
Date
Quantity
used
Balance
remaining
Use
Information
Initials
Research information,
e.g., animal wt