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Compounding Record

Formula Number :

A. Product

Drug Name AND Strength Use/Dosage Form Date

LOT BUD Quantity Control/Rx #

B. Ingredient Breakdown

INGREDIET NDC QTY LOT

C. PREPARATION

COMPOUNDING DIRECTIONS AND PROCEDURES


Include mixing order, mixing temps & other environmental controls, duration of mixing, and other factors pertinent to the replication of the preparation as compou
NOTES:

Weighed by : QC Check by :

Prepared by : Approved by :

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