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Get DE Controlled Substance Count Sheet

T AMOUNT ON USED HAND Quantity: _______________ AMOUNT SIGNATURE LEFT Page 2 Controlled Substance Count Sheet (continued) Individual’s Name: _______________________________ Medication/Strength: _____________________________ Prescription Number: _____________________________ DATE TIME AMOUNT AMOUNT ON USED HAND PARC Approved: 06/24/08 Form #25 CS/ASP Quantity: _______________ AMOUNT SIGNATURE LEFT .

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