Approved Formulary
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Approved Formulary
Pharmacy Forms

Forms:

Alaris Alert Override Form 

Annual Survey of Preceptor Development Needs

Anomalous Usage Report Response Form (not for Anesthesia

Anomalous Usage Report Response Form For Anesthesia Department 

Black Bin Hazardous Waste Log  

CCT Narcotic Kit Inventory and Waste Form  

Checklist for Inspection of Eyewash Equipment  

COA Controlled Substance Diversion Response Flowchart  

COA Pneumatic Tube Directory 

Code Drug Sheet  

Code Recons  

Compounded IV Bag Preparation Log  

Controlled Substance (CS) Perpetual Inventory Form  

CS Diversion Response Flowchart  

CS Process Flowchart 

CSI Report Template  

Daily IV Count  

Daily Reconstitution Log 

Do Not Tube List 

Emergency Cart MEDICATION Inventory Sheet 

Emergency Induction Kit Exterior Med Card  

Emergency Kit Change Request Form  

Hazardous Medication List  

Home Medication (HM) for PATIENT USE Log (Pharmacy Use Only)  

Home Medication (HM) for STORAGE Log (Pharmacy Use Only) 

Initial Application for Pharmacy Residency Preceptors  

Investigational (Study) Medication ROOM TEMPERATURE Log Sheet  

IV Syringe Preparation Log 

Malignant Hyperthermia Cart Exterior Med Card 

Medication Freezer Log 

Medication Override List  

Medication Refrigerator Log  

Medication Replacement Request Form 

Medications Received Log  

Oral Medication Monthly Report 

Oral Medications Expiration Dates 

Oral Syringe Medication QA Worksheet  

Pharmacy Daily Safety Report 

Pharmacy Department Record of Lending and Borrowing Drugs  

Pharmacy Department Request for Day(s) Off  

Pharmacy Machine Application Downtime Algorithm 

Pharmacy MEDICATION Log for Emergency Carts  

Pharmacy PTO Request Form  

Pharmacy Requisition Form for Clinics and PPS 

Preceptor Academic and Professional Record 

Preceptor Annual Self-Assessment  

Procedure for Management of Absorbable Deactivator for Controlled Substance Disposition 

Pyxis MedStation Access Change or Removal Request

Receipt of Tubed Medication 2013  

Request for Alaris Dataset Review 

Request for Automated Medication Override Review 

Request for Formulary Review

Residency Applicant Interview Evaluation Tool 

Residency Applicant Pre-Interview Evaluation Tool

RIVA Tracking Sheet for Intermediary Training 

RIVA Tracking Sheet for VIAL Training  

Shift Swap Agreement  

Special IV Record 

V-Survey User Access Request or Change Form 

 

Pharmacy Phone Numbers:
Inpatient Pharmacy: 205-638-9641
IV Room: 205-638-9716
Pharmacy Offices: 205-638-9718

This site is intended for Children's Health System health professionals and employees only.
Use by pharmaceutical/medical representatives or non-CHS personnel is strictly prohibited.