Healthcare Pharmacy Audit Form

Healthcare Pharmacy Audit Form

This Pharmacy Audit Form documents the on-site review of pharmacy operations, records, inventory controls, and regulatory compliance. Information recorded herein is subject to applicable confidentiality requirements and may be retained for compliance review, corrective action monitoring, and regulatory reporting where required.

Audit Details

Audit Date:   Start Time:   End Time:

Routine audit    For-cause audit    Follow-up

Primary Contact & Licensing

DEA Registration Number:   DEA Expiration Date:

Inventory Controls — Controlled Substances

Secure storage for controlled substances (locked cabinet/safe): Yes No

Perpetual inventory maintained for Schedule II medications: Yes No

Prescription Records & Dispensing Practices

Original paper prescription retention policy in effect: Yes No

Electronic prescription audit trail retained: Yes No

Storage, Security & Environmental Controls

Alarm system operational for medication areas: Yes No

Temperature monitoring for refrigerated medications: Yes No

Policies, Procedures & Staff Training

Written policies and procedures for dispensing available on-site: Yes No

Waste Handling, Returns & Destruction

Documented destruction logs for returned or expired controlled substances: Yes No

Adverse Events, Incidents & Diversion Reporting

Any suspected diversion identified during audit: Yes No

Findings & Observations

Corrective Action Plan (CAP)

Attachments / Documents Reviewed

Inventory records (controlled substances)
Dispensing logs and prescription records
Staff training records
Policies & procedures

Certifications & Attestations

Pharmacy Representative certifies that the information and documents provided to the auditor are complete and accurate to the best of their knowledge. Pharmacy agrees to implement the corrective actions described in this form within the agreed timeframe and to provide supporting documentation of completion. False statements made in this audit report may be subject to disciplinary or regulatory action.

Auditor certifies that findings recorded were observed during the on-site audit and that this report accurately reflects the conditions and records reviewed. Auditor agrees to maintain confidentiality of patient-identifiable information in accordance with applicable law and professional standards.

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