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 :