Master Formulation Record
Pharmacy compounding of non-sterile preparations
Name of compounded product: Protocol number and version:
Concentration: Effective date:
(dd/mm/yy)
Pharmaceutical form: Developed by:
Route of administration: Verified by:
Formula
Ingredients: Quantities: Physical description: Other information (i.e.
DIN, lot number, man-
ufacturer, expiry date,
expected yield)
Additional information about the ingredients:
Notes on calculations and measurements:
Required equipment, instruments, and materials:
Compounding method:
Quality controls:
Packaging:
Stability and storage:
Labelling: Sample label:
Patient label:
Training:
References consulted:
Preparation date sheet history #:
Revised: Revised by:
(dd/mm/yy)
Change made:
Version number changed: Yes No
Revised: Revised by:
(dd/mm/yy)
Change made:
Version number changed: Yes No