CD DESTRUCTION TEMPLATE

							                                                                                                            Hartlepool Primary Care Trust
                                                                                            Stockton-on-Tees Teaching Primary Care Trust
NAME OF PRACTICE / COMM PHARMACY……………………………………………………

CD DESTRUCTION TEMPLATE
(To be completed immediately by practice staff once out of date stock is identified)

 DATE      NAME OF DRUG      STRENGTH OF    FORM OF DRUG           NO. OF TABLETS   DATE DRUG    NAME OF PERSON        DATE
                                DRUG         i.e. tablets, vials      OR VIALS       EXPIRED    COMPLETING FORM   DESTROYED- SEE
                                                                                                                     REGISTER




                                                                                        1                     05/02/2010