Medication Dispensing Verification Checklist Form
Complete this checklist to verify safe and accurate medication dispensing before release.
Patient First and Last Name
*
First Name
Last Name
Medication Name
*
Medication Strength (e.g., 500 mg, 10 mL)
*
Dosage Instructions
*
Quantity Dispensed
*
Medication Expiry Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Prescriber Name
*
Allergies Checked?
*
Yes
No
Not Applicable
Medication Label Verified (correct patient, drug, dose, route, time)?
*
Yes
No
Dispenser Name/Initials
*
Submit Checklist
Should be Empty: