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Get Rockhill Pharmacy Medication Destruction Form

____________ Resident Name: _________________________________________________________________ Medication Destroyed for the Following Reason(s): 1) Expired RX NUMBER 2) Not in Manufacturer’s Original Container DISPENSE DATE 3) Controlled Medication 4) Opened Package MEDICATION / STRENGTH Medications rendered useless and placed in the following: QTY REASON FOR DESTRUCTION Biohazard Container Witnessed By: _______________________________________________ Name / Title Witnessed By: ____.

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