SRC Drug Return Request (2021) V.2

Drug Return Request Details

All medication returns to the pharmacy must be authorized by pharmacy. A pharmacy staff will provide return instructions upon receipt of the return request. Do NOT send any medications back to the pharmacy without first receiving authorization from the pharmacy to do so.

Identify SRC and the person completing the return request.

Question Title

* 1. Subregional Clinic

Question Title

* 2. Full Name of person completing return request

Question Title

* 3. Pages are separated alphabetically by the name of the medication(s) to be returned. Which page of the return request would you like to go to?

2. A

3. B-C

4. D

5. E-H

6. I-L

7. M

8. N-O

9. P

10. Q-S

11. T-Z

12. Patient Specific Medications (Patient Prescriptions)

13. Patient Specific Clinic Stock Medications never picked up by the patient

14. Other meds not on the formulary (non-patient prescription)