CS Form 3 MARQUETTE UNIVERSITY RECORD OF CONTROLLED SUBSTANCES ADMINISTERED/DISPENSED Name of Controlled Substance: Form: Strength: Size: Initials of Amount Species of Person Previous Administered/ New Date Patient/Animal Name & Address Animal Administering/ Balance Dispensed Balance Dispensing (or Purchased) Revised: 4/16/2013
CS Form 3 MARQUETTE UNIVERSITY RECORD OF CONTROLLED SUBSTANCES ADMINISTERED/DISPENSED Name of Controlled Substance: Form: Strength: Size: Date Patient/Animal Name & Address Species of Animal Initials of Person Administering/ Dispensing Previous Balance Amount Administered/ Dispensed (or Purchased) New Balance Revised: 4/16/2013