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

Sp-6 Medication Administration and Management Policy

Attachment I – Medication Disposal Sheet

Rev.: Feb. 2014