Sample Medication
Label Recording System

Meets Federal and State Regulations as they pertain to
documenting the dispensing of SAMPLE MEDICATIONS

Sample Medication Label Recording System

The SecureGuard™ Custom Imprinted Sample Medication Recording System
lets you write ONCE to create Two Labels and a Record Copy !

3 parts to Sample Medication Recording System

What issues must be considered relating to sample medications?

Click to read what is said by the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Treat Medication Samples with Respect
Information from The Institute for Safe Medication Practices

All prescription drug samples dispensed to patients
must include instructions that meet State and Federal guidelines.

The SecureGuard™ Sample Medication System is Imprinted with
the Practice Name, Address and Phone Number.
Our Standard Format meets all regulations.

The STANDARD FORMAT includes room for:
  • the prescriber’s name
  • the patient’s name
  • the date
  • the Rx Medication name
  • dosage of the drug
  • It is essential to provide written instructions on how to take the drug
  • All special instructions must be included,
    similar to the instructions on a prescription filled by a pharmacist
  • Special Instructions can be written on a label and placed on the sample package
    a zip-lock bag or an inexpensive brown lunch bag.

Dispensing Sample Medication

The SecureGuard™ Sample Medication Label Recording System is Easy-to-Use.

Give the required instructions to your patient

Give the required written instructions to your patient.
The Green-bordered label affixes right to the medication sample.
Your directions won’t get lost, or forgotten. This means fewer phone calls!

The Purple-bordered label affixes to patient’s chart

Update the patient’s file.
The Purple-bordered label affixes direct to the patient’s chart. You know exactly what medications you gave to your patient and the instructions you issued.
This is a "write-it-once" system.

Keep a separate record of all sample medications

Keep a separate record of all sample medications in one location.

Pre-punched duplicate log sheet slips easily into the binder.
Record any useful information relative to drug recalls or inventory.

Ready to Order ~~~
Special Offer ...
with your FIRST ORDER

Sample Medication Label Recording System with Landscape Clipboard

If you dispense Sample Medications ...
You need the SecureGuard™ Sample Medication Label Recording System

Copyright © 2008- Micro Format, Inc., All Rights Reserved
Micro Format, Inc
830-3 Seton Court ~ Wheeling, IL 60090
800/333-0549 ~ FAX 847/520-0197