Pharmacy Deployment Forms

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Pharmacy Deployment Forms

• Lessons Learned from Hurricanes Katrina, Rita,
  and Wilma - Lack of forms to keep track of
  patient
• records, drug supplies, and credentialing
• information in clinics or federal medical
  stations (FMSs)
• Need for standardized pharmacy forms
• Developed by members of PharmPAC Public
• Health Pharmacy Workgroup and
• PHS RDF team (Pharmacy Branches)

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Pharmacy Deployment Forms

• Continual improvement based on field testing
  or
• actual use (Deployment Forms Workgroup
• will meet on a quarterly basis to make
• updates)
• PHS Forms have been approved by the PharmPAC
  and will be posted on the
• PharmPAC website soon
• Not intended to replace other forms
• available during a deployment mission,
• but available as needed based on
• the needs of the mission and pharmacy

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Pharmacy Deployment Forms

• Administrative Forms
• PHS FORM ADM-001 RPh record and credentialing
• PHS FORM ADM-002 Important Contacts
• (federal, state, local)
• PHS FORM ADM-003 Prescriber record and
  credentialing
• PHS FORM ADM-004 Controlled Substance (CII)
  Inventory Log
• PHS FORM ADM-005 Controlled Substances (CIII-CV)
  Inventory Log
• PHS FORM ADM-006 Controlled Substance Medication
  
• Administration Log
• PHS FORM ADM-007 Prescription Forms

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PHS FORM ADM-002
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PHS FORM ADM-007
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Pharmacy Deployment Forms

• Administrative Forms
• PHS FORM ADM-008 Immunization Log
• PHS FORM ADM-009 Refrigerator/Freezer
  Temperature Log
• PHS FORM ADM-010 Room Temperature Log
• Clinical Form
• PHS FORM CLN-001 Medication Reconciliation
• Order Form

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PHS FORM CLN-001
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Pharmacy Deployment Forms
Once forms are available on the PharmPAC website
comments or suggestions can be submitted to
LCDR Binh Nguyen and LCDR Connie Jung (Work Group
Leads) for review by the Deployment Forms Work
Group binh.nguyen_at_fda.hhs.gov connie.jung_at_fda.hhs
.gov