Legislation and Supporting Documents Practice Resources Pharmacy Technicians Expanded Scope of Practice Forms & Pharmacy Signs Implementation of the December 2006 Pharmaceutical Act

Forms and Pharmacy Signs

The College of Pharmacists of Manitoba(formerly known as the “Manitoba Pharmaceutical Association”) continues to adapt the content on www.cphm.ca in order to reflect the December 2006 Pharmaceutical Act, implemented January 1, 2014. The documents on the website with “Manitoba Pharmaceutical Association” or “MPhA” have not been updated and may not be consistent with the current legislation. Questions on this content can be directed to the College office.

Narcotic Forms:

Loss or Theft Report Form for Controlled Substances and Precursers

The Office of Controlled Substances has released a new Guidance Document – Reporting of Loss or Theft of Controlled Substances and Precursors and includes a new Loss or Theft Report Form for Controlled Substances and Precursors. This guidance document and accompanying report form take effect immediately.

Loss or Theft Report Form for Controlled Substances and Precursers (College & HC)

Please review the Guidance Document as the process for reporting has been updated and standardized for ease of use. 

Forgery Report for Narcotic, Controlled and Targeted Substances (College & HC)

Sample Destruction of Drugs Covered by the  Controlled Drugs and Substances Act  ( PDF version

Sample Form for Narcotic Acquisition Log

Sample Form for Sales Reportable Narcotic Report

Sample Form for Perpetual Inventory Log

Sample Form for Expired and Returned CDSA Drug Inventory Count

College Pharmacy Signs:

College Sign: Accepting Drugs for Return to Inventory

College Sign: Proof of Identity

College Sign: It's Your Right to Know

College Sign: Updated Personal Health Information

Pharmacy Standards Forms:

Sample Template for Pharmacy Policy and Procedures Manual Content

Pharmacy Quality Assurance Self-Assessment

Medication Incident and Discrepancy Report Form

Medication Incident and Discrepancy Report Log

Clinical Practice Pharmacy Policy & Procedure Manual

Health Canada Forms

Canada Vigilance Adverse Drug Reaction Reporting Form 

Loss or Theft Report Form for Controlled Substances and Precursors