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01. Edit your drug disposal log online
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How to use or fill out North Dakota Attorney General Take Back Program with our platform
- Click ‘Get Form’ to open the North Dakota Attorney General Take Back Program document in the editor.
- Begin by filling in the 'FACILITY' and 'STREET ADDRESS' fields at the top of the form. Ensure that all information is accurate for proper identification.
- Next, circle the appropriate calendar quarter that corresponds to when you are submitting this form. This helps in organizing records effectively.
- In the table provided, enter details for each destroyed medication. Fill in the 'Date Dispensed', 'RX #', 'RESIDENT'S NAME', 'NAME OF PHARMACY', and 'DRUG'.
- For each entry, specify the 'Quantity', 'Strength', and 'METHOD OF DESTRUCTION'. This ensures compliance with disposal regulations.
- Finally, have two witnesses sign in the designated areas and ensure that a consultant pharmacist's name is included under 'DESTROYED BY'.
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