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Sample Medication Dispensing
Label Recording System


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

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Sample Medication Label Recording System

The SecureGuardTM 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)

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 SecureGuardTM 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 SecureGuardTM 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.



  • Item Number: SP808-1
    SAMPLE MEDICATION LABEL Recording System
    100 sets (1400 medications) ... $290.00 including custom imprint
    plus shipping by UPS


  • Item Number: SP808-2
    SAMPLE MEDICATION LABEL Recording System
    250 sets (3500 medications) ... $575.00 including custom imprint
    plus shipping by UPS


  • Ready to Order ~~~
    SECURE ORDER FORM
    Click For SECURE ORDER FORM
    Special Offer ...
    FREE Side Grip CLIPBOARD
    with your FIRST ORDER

    Sample Medication Label Recording System with Landscape Clipboard


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


    Copyright © 2008-2010 Micro Format, Inc
    All Rights Reserved
    Micro Format, Inc.
    830-3 Seton Court ~ Wheeling, IL 60090
    800/333-0549 ~ FAX 847/520-0197