Ocean View Community Hospital

Saferating OceanView Demonstration Area

Medication Sample Management Application

The Joint Commission and most State Boards of Pharmacy mandate that when samples are dispensed to a patient, the medication(s) shall be logged out and a label producted that satisfies regulatory bodies.

This assures a method to recall the medication in the event a manufacturer recall occurs.

Additionally the patient receives medication with proper labeling.

Our Paperless Form Technology™ will record the transaction in a retrievable database, but additionally will produce a post submission message that can be utilized as a label and a hard copy for the patient\'s chart.

	NOTE: Fields marked with "*" are required.

Date (mm/dd/yyyy):
Patient Last Name:
Patient First Name:
Lot Number:
Medication Name*:
Medication Strength:
Doses Dispensed*:
Prescription SIG:
Prescriber: