6.
DA Form 3875 is used for ordering and issuing noncontrolled medications and
solutions. The form is initiated by the __________________________________.
7.
Name two things for which the DA Form 3875 cannot be used.
a. ____________________________________________________________
b. ____________________________________________________________
8.
Name items that must be contained within the bulk drug order form.
a. ____________________________________________________________
b. ____________________________________________________________
c. ____________________________________________________________
d. ____________________________________________________________
e. ____________________________________________________________
f.
(including
,
,
, and
_________________________).
9.
A patient care area puts in a bulk drug order on the DA Form 3875 on the following
page. You are to fill the order. Make the correct notations for the following
situations on the DA Form 3875. Be sure to initial the order.
a. You are able to provide the Vistaril injection in the amount requested.
b. You are only able to supply 4 bottles of the Mylanta liquid, but you expect
the remainder to be available in 3 days.
You substitute hydrochlorothiazide for the Hydrodiuril 50 mg.
c.
d. You are temporarily out of Lotrimin* cream 15 gm. You expect more in 5 days.
e. You do not stock Sinequan* 50 mg. But you recommend Adapin 50mg
instead.
Xanax 0.25 mg is a controlled item.
f.
MD0811
1-9