Narcotic Count / Controlled Substance Log
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1Narcotic Count / Controlled Substance Log
Patient Name: _____________________________________________________________ Date Received: ___________________
Prescriber Name: ___________________________________________________________ Quantity Received: ________________
Medication Name/Strength: _____________________________________ Directions: ____________________________________
#
Date
Time
Amount on Head
Amount Given
Amount Remaining
Signature
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Parent category: Medical