Narcotic Count / Controlled Substance Log
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1Narcotic Count / Controlled Substance Log
15812 SE 114th Ave
Clackamas, Oregon 97015
Website:
Phone (503) 908-0630
Email:
Fax (503) 908-0865
Patient Name: _______________________________________ Date Received: _______________
Prescriber Name: ___________________________________ Quantity Received: ____________
Medication Name/Strength: ______________________Directions: _________________________
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Time
Amount on Hand
Amount Given
Amount Remaining
Signature
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Parent category: Medical