[Insert organisation CONTROLLED DRUG STOCK BALANCE CHART logo here] Developed for any patient who requires their medications delivered via syringe pump Patient Name: Medication: Form: Strength: DOB: Opening stock balance transferred from page no: NHS Number: This page no: Opening stock Closing stock Dose given Wasted balance received into balance / amount Date: Time: Sign & print: (milligram / (milligram / stock removed for disposal microgram): microgram): (no. ampoules) (no. ampoules) Closing balance transferred to new balance chart. Page No: Sign & print: OR Closing stock balance disposed of enter details of disposal in patient notes. Sign & print: –
CONTROLLED DRUG STOCK BALANCE CHART Developed for any patient who requires their medications delivered via syringe pump [Insert organisation logo here] Patient Name: Medication: Form: Strength: DOB: Opening stock balance transferred from page no: NHS Number: This page no: Date: Time: Opening stock balance received into stock (no. ampoules) Dose given (milligram / microgram): Wasted (milligram / microgram): Closing stock balance / amount removed for disposal (no. ampoules) Sign & print: Closing balance transferred to new balance chart. Page No: Sign & print: OR Closing stock balance disposed of – enter details of disposal in patient notes. Sign & print:
CONTROLLED-DRUG-STOCK-BALANCE-CHART_100817.docx