Form NDP16 "Medication Destruction Record" - Alabama

What Is Form NDP16?

This is a legal form that was released by the Alabama Department of Mental Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Alabama Department of Mental Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NDP16 by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.

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Download Form NDP16 "Medication Destruction Record" - Alabama

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NDP 16
July 2018
MEDICATION DESTRUCTION RECORD
Date
Name of Drug
Dose
Form
#
Reason
Person’s Name
Signature #1/Credentials
Signature #2/Credentials
(Rx #)
of Drug
(pills,
Discarded
Code
caps,
gtts, etc.)
REASON CODES:
1. Med discontinued by prescriber
2. Person experienced adverse reaction
3. Person expired
4. Person discharged
5. Other – MUST EXPLAIN ON BACK
DESTRUCTION RECORDS MUST BE MAINTAINED AT LEAST TWO YEARS (2)
1
NDP 16
July 2018
MEDICATION DESTRUCTION RECORD
Date
Name of Drug
Dose
Form
#
Reason
Person’s Name
Signature #1/Credentials
Signature #2/Credentials
(Rx #)
of Drug
(pills,
Discarded
Code
caps,
gtts, etc.)
REASON CODES:
1. Med discontinued by prescriber
2. Person experienced adverse reaction
3. Person expired
4. Person discharged
5. Other – MUST EXPLAIN ON BACK
DESTRUCTION RECORDS MUST BE MAINTAINED AT LEAST TWO YEARS (2)
1
NDP 16
July 2018
EXPLANATIONS/COMMENTS
All Notations Must Be Dated and Signed by MAS Nurse
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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