Daily data collection

Data Collection Form 2

This data collection form can be used to record owings on a daily basis during the whole audit period.
Print out and complete one form per day.

Use Data Collection Form 3 to calculate your weekly owings figures, and Data Collection Form 4 to
calculate items owed over the whole audit period.

From ..../..../....
Whole audit period
To ..../..../....

Date
.................................................................

Patient issued
Patient informed written note
Item owing (eg medicine Record of owing
Reason (see when medicine detailing item
name, strength, made in patient’s
key below) expected to be owed, including
formulation medication record
available quantity
outstanding

Total number of owings

today .................................
Total items dispensed
today .................................

Reasons for owings:

Extemporaneous preparation requiring
A Incorrect stock level I
ingredient(s)
B New or unusual item J Special
Expensive item to be ordered in for regular
C K Stock ordered but not received
patient
D Unusually high demand L Stock out of date
Unusually high amount prescribed on one
E M Other (state here)
prescription
F Wholesaler is out of stock N Other (state here)
G Manufacturer is unable to supply O Other (state here)
H Out of stock on a Sunday/Bank Holiday