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S-Registers
PDEA form for S-registers
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PDEA S Register 1-14
(Records required of a drugstore)
Brand Name / Dosage Strength and Form
OUT
IN
Date
Received
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued
Quantity
Received
Date
Dispensed
Initial Stock / Balance Forwarded _____
Patient Information:
Name, age, address
SPFDD
SN
S2
license
No
Practitioner Information: Name, address
Quantity
Dispensed
Balance
Remarks
Ex. Name
of buyer or
sent
through
courier,etc.
Transfer of drugs other than through Rx
Returns by patient
shall be covered by an appropriate permit
to be entered in the
(ex. Return stocks to supplier,
IN columns
Surrender to PDEA)
PDEA S Register 2-14
(Records required of a hospital pharmacy)
Brand Name / Dosage Strength and Form
IN
Date
Received
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued
Quantity
Received
Page No.
OUT
Date
Dispensed
Initial Stock / Balance Forwarded _____
Initial Stock / Balance Forwarded _____
Patient Information: Name, age, ward
or
Ward Information: Name of Ward, Receiving nurse
Rx/Order
No
or
Requisition
No.
S2
license
No
Practitioner Information:
Name, Department
Quantity
Dispensed
Balance
Remarks
Ex.OutPx / In-Px
/
Ward
Stock,etc.
Transfer of drugs other than through
Rx/Order and ward requisitions shall be
Returns by patient
covered by an appropriate permit
to be entered in the
(ex. Return stocks to supplier,
IN columns
Medical Missions, Surrender to PDEA)
PDEA S Register 3-14
(records required of a distributor)
Page No.
Brand Name / Dosage Strength and Form
OUT
IN
Date
Received
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued
Quantity
Received
Date Sold
or
Delivered
Initial Stock / Balance Forwarded _____
Name of Purchaser
Address
S4 / S3
license No
Local Permit
No.
Name of
Trucker
/Carrier
Quantity
sold or
delivered
Balance
All transfer of drugs
shall be covered by
an appropriate permit
Returns by clients
including return stocks
to be entered in the
to supplier, surrender to
IN columns
PDEA
Note: If distributor has an agreement with another licensed company (ex. Principal Company), the imported DD directly delivered to distributor company shall be reflected as follows. If importer
shall retain samples, it shall be duly recorded.
Exporter: ABC Company,Japan
02Jan2012
Importer: Principal Company, Mkti
S5-I No: 00123001-N001
IP#123, AC#321dtd 11July2012
1000 tablets
1000tabs
03Jan2012
Principal Company
...
...
n/a
Pick-up by
principal
5tablets
995tablets
PDEA S Register 4-14
(Records required of an importer/distributor of raw material/s)
Page No.
Name of Raw Material
OUT
IN
(Arrival at
Port of
Entry)
and Date
Received
Supplier Information:
Exporter name, country of
origin, IP No. and date issued
Quantity
Received
(as verified
by PDEA
Officer)
Date Sold
or
Delivered
Initial Stock / Balance Forwarded _____
Name of Purchaser
All transfers shall be
covered by an
Returns by clients
appropriate permit
to be entered in the
including surrender to
IN columns
PDEA
Address
S5C license
No
Local Permit
No.
Name of
Trucker
/Carrier
Quantity
sold or
delivered
Balance
PDEA S Register 5-14
(Records required of an importer/distributor of finished products)
Page No.
Brand Name / Dosage Strength and Form
OUT
IN
(Arrival at
Port of
Entry)
and Date
Received
Supplier Information:
Exporter name, country of
origin, IP No. and date issued
Quantity
Received
(as verified
by PDEA
Officer)
Date Sold
or
Delivered
Initial Stock / Balance Forwarded _____
Name of Purchaser
Address
S4 / S3
license No
Local Permit
No.
Name of
Trucker
/Carrier
Quantity
sold or
delivered
Balance
All transfers shall be
covered by an
Returns by clients
appropriate permit
to be entered in the
including surrender to
IN columns
PDEA
Note: If importer has a storage/distribution agreement with another licensed company (ex. Company X), the imported DD may be delivered directly to Company X upon arrival, if importer secured
own S5-D license for Company X address. If retention stocks are to be retained by importer, it shall be duly reflected in the records, ex:
1Jan2012
ABC Company,Japan
IP#123, AC#321dtd 11July2012
1000 tablets
1000tabs
2Jan 2012
3jan2012
Company X
S5D license#...
re. IP#123...
as retention Sx
5tablets
Company X
Canlubang, Laguna
S4-234005R012
Direct delivery
upon importation
to importer’s S5D whse(Co X)
GHI Delivery
Services
1000tabs
0
5tablets
(retention
Sx)
PDEA S Register 6A-14
(Records required of a manufacturer of finished products)
Page No.
Name of Raw Material
OUT
IN
Date
Received
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued.
-----------If imported, Exporter name,
country of origin, IP No. and
date issued
Quantity
Received
Date Used
Initial Stock / Balance Forwarded _____
Purpose:
Name, dosage strength and form of finished
product to be manufactured
Expired RMs to be surrendered
to PDEA through use of local
Permit
Theoretical Yield (and Actual Yeld,
if it differs with the T Yield)
Lot/Batch
Number
Local Permit
No.
Quantity
used
Balance
Remarks
PDEA S Register 6B-14
(Records required of a manufacturer on distribution of its manufactured finished products)
Page No.
Brand Name / Dosage Strength and Form
OUT
IN
Date
Manufactured
Manufacturing Local Permit No
and date issued
Date Sold
or
Delivered
or
exported
Quantity
manufactured
(Actual Yield)
Initial Stock / Balance Forwarded _____
Name of Purchaser
Address
S4 / S3
license No
Local Permit
No. or Export
Permit No.
Name of
Trucker
/Carrier
Quantity
sold or
delivered
Balance
All transfer of drugs
shall be covered by
an appropriate permit
Returns by clients
including return stocks
to be entered in the
by clients, surrender to
IN columns
PDEA
Note: If retention stocks are to be retained by manufacturer, it shall be duly reflected in the records, as follows:
5000tabs
...
Retention sample for batch #...
(Please see separate register for retention stocks)
n/a
n/a
n/a
100 tablets
retained
4900tabs
PDEA S Register 7-14
(Records required of a n S6 holder-for use in Research / Laboratory)
Page No.
Raw Material (name, form, concentration or purity)
or Finished Product (Brand Name / Dosage Strength and Form)
OUT
IN
Date
Received
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued.
-----------If imported, Exporter name,
country of origin, IP No. and
date issued
Initial Stock / Balance Forwarded _____
Details of Usage / Dispensation
Quantity
Received
Date Used
or
Dispensed
Research Subject (Person or animal), if any:
Name, age, address
SPFDD
SN
S2
license
No
Practitioner Information: Name, address
Remarks
on usage
to subject
Quantity
Used or
Dispensed
Balance
PDEA S Register 8-14
(Records required of an S6 holder -for use in Training school conducting programme for K-9)
Page No.
DD (name, form, concentration or purity, training aid/container no, if any, and type of container)
IN
Date
Received
OUT
Supplier Information:
Name, address, PDEA
license no / Local Permit No
and date issued.
-----------If imported, Exporter name,
country of origin, IP No. and
date issued
Quantity
Received
Net
wt
Gross
wt
Received
By
(Custodian’s
Signature)
Initial Stock / Balance Forwarded _____
Date used
for
training
Time
Weight
Location of
training
Received by
(Handler’s
Signature)
Date
Returned
Time
Weight
Received by
(Custodian’s
signature)
Balance
Remarks
Note: A controlled substances accountability register or folder shall be kept for each separate controlled substance training aid shipment or issue from the supplier. A new folder is started
whenever procurement of controlled substance is initiated
PDEA S Register 9-14
(Records required of a licensee keeping Retention Samples)
Page No.
Raw Material (name, form, concentration or purity)
or Finished Product (Brand Name / Dosage Strength and Form)
IN
Date
Manufactured/
Imported
OUT
Manufacturing Local Permit No
or Import Permit No.
-----------and Batch No. or any other
identifying info
Quantity
Retained
Date
Disposed
Initial Stock / Balance Forwarded _____
Details of Disposal
Local Permit
No.
Quantity
disposed
Balance
Remarks
PDEA S Register 10A-14
(Records required of an S2 licensed physician or dentist acquiring dangerous
drug stocks in accordance with Section 30(1)(c)(ii) or other special case/s
Brand Name / Dosage Strength and Form
OUT
IN
Date
Received
Page No.
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued
Quantity
Received
Date
Prescribed
and
Dispensed
Initial Stock / Balance Forwarded _____
Patient Information:
Name of Patient
Transfer of drugs other than
through Rx shall be covered by
an appropriate permit, including
surrender to PDEA
Age
Address
SPFDD No.
Quantity
Dispensed
Balance
Remarks
PDEA S Register 10B-14
(Records required of a S2 licensed veterinarian acquiring dangerous drug stocks
in accordance with Section 30(1)(c)(ii)
Page No.
Brand Name / Dosage Strength and Form
Initial Stock / Balance Forwarded _____
Date
Received
Supplier Information:
Name, address, PDEA license
no / Local Permit No and date
issued
Quantity
Received
Date
Prescribed
and
Dispensed
Patient and Owner Information:
Name of
Animal Patient
Transfer of
drugs other than
through Rx
shall be covered
by local permit
Ex. Surrender to
PDEA
Identifying marks
Owner’s Name
Address
SPFDD No.
Quantity
Dispensed
Balance
Remarks
