Admit/Discharge
Admit/Discharge
Admit/Discharge
ADMIT/DISCHARGE
RESIDENT___________________ ADMIT DATE________ DISCHARGE DATE_________
RX MEDICATI # WASTED/ DATE # INITIAL
NUMBER ON INCOMING INITIAL OUTGOING
ADMIT CMA SIGNATURE _________________________________ DATE_____________
PERSON RESPONSIBLE____________________________________ DATE_____________
DISCHARGE CMA SIGNATURE ______________________________DATE_____________
PERSON RESPONSIBLE____________________________________ DATE_____________