CONTROLLED DANGEROUS SUBSTANCES WORKSHEET Form Pharmacy: Permit#: Date: Pharmacist Signature: Rx#: Date Filled: DRUG NDC Number ON HAND PERPETUAL INVENTORY INVENTORY COMMENTS: SCHEDULE II AUDIT Drug Date of last Inspection/Biennial Amount at last inspection/biennial (A) Purchased since inspection/biennial (B) Total inventory (C) = A + B Quantity dispensed (D) Expected inventory (E) = C - D Quantity on Hand (G) = (F-E) or (E-F) Discrepancy Excess Shortage INVOICE REVIEW (F) CII: CIII - CV:
CONTROLLED DANGEROUS SUBSTANCES WORKSHEET Pharmacy: Permit#: Date: Pharmacist Signature: Form Rx#: Date Filled: DRUG NDC Number ON HAND INVENTORY PERPETUAL INVENTORY COMMENTS: SCHEDULE II AUDIT Drug Date of last Inspection/Biennial Amount at last inspection/biennial Purchased since inspection/biennial (A) (B) Total inventory (C) = A + B Quantity dispensed (D) Expected inventory (E) = C - D Quantity on Hand Discrepancy (F) (G) = (F-E) or (E-F) Excess Shortage INVOICE REVIEW CII: CIII - CV:
Community%20Inspection%20Form.docx