[Pharmwaste] general pharmaceutical waste questionnaire

[Matthew Mireles]

Andrew,

There are four versions of the data collection form for a proposed national
registry for unused and expired meds.  Each of the forms is designed to be
incorporated into a database (categorized by types of collection, e.g.
individual dontation vs. bulk collection, etc.). I'd be happy to work with
you on modifying any of our forms to meet your needs.  And I encourage you
to join us in standardizing a format by which we all can collect basic data
about returned drugs.  Dr. Stevan Gressitt has provided the most simple
format.

Matthew Mireles, PhD, MPH
CRG Medical Foundation for Patient Safety
832-778-7777



-----Original Message-----
From: gressitt@uninets.net [mailto:gressitt@uninets.net] 
Sent: Monday, August 29, 2005 8:13 AM
To: Gilliam, Allen; Stevan Gressitt; pharmwaste@lists.dep.state.fl.us
Cc: mirelesmc@earthlink.net
Subject: Re: [Pharmwaste] general pharmaceutical waste questionnaire

Andrew, We understand that there is a range of situations.
WE also know full well that there are places that simply
need compact data. So I suggest the original form which is
onthe web page. 4 columns: drug, dose, count, why
discarded/unused. That was it. 

See below:
 National Unused Pharmaceutical Return Registry

Collector or Collection Sponsor:					
Contact Person, email, phone, address:					
					
Date(s) From:_____ To:_____					
Page___of ___					
					
	ZIP CODE	DRUG	STRENGTH	QUANTITY	WHY UNUSED?
1					
2					
3					
4					
5					
6					
7					
8					
9					
10					
11					
12					
13					
14					
15					
16					
17					
18					
19					
20					
					
National Unused Pharmaceutical Registry					
Program Description ( Attach or use reverse)

Return form to: mbsg@noemaine.org					
version 1.1					
					


On Mon, 29 Aug 2005 07:35:00 -0500
 "Gilliam, Allen" <GILLIAM@adeq.state.ar.us> wrote:
> thanks Stevan (and Matthew),
>  
> there's been more than a handful of city w.w. officials
> asking about
> some simple form they could send out to their potential
> contributors,
> other than individuals.  modifying what Matthew (and
> team) put together
> would take some time.  what i'm looking for should fit on
> a page or two.
> something more general.  ndc#s?  you bet!
>  
> thanx for the forward Stevan and y'all have a cool week,
>  
> allen gilliam
> adeq state pretreatment coordinator
> 501.682.0625 
> 
> 	-----Original Message-----
> 	From: Stevan Gressitt [mailto:gressitt@uninets.net] 
> 	Sent: Sunday, August 28, 2005 10:08 AM
> 	To: Gilliam, Allen; pharmwaste@lists.dep.state.fl.us
> 	Cc: mirelesmc@earthlink.net
> 	Subject: RE: [Pharmwaste] general pharmaceutical waste
> questionnaire
> 	
> 	
> 
> 	Matthew Mirelles is an epidemiologist whose team
> designed the
> forms you refer to. He has some other variations and I am
> forwarding
> this to him. Perhaps a direct connection would help
> refine what is
> available. Stevan Gressitt, M.D. 207-441-0291 
> 
> 	 
> 
> 	
> ________________________________
> 
> 
> 	From: pharmwaste-admin@lists.dep.state.fl.us
> [mailto:pharmwaste-admin@lists.dep.state.fl.us] On Behalf
> Of Gilliam,
> Allen
> 	Sent: Friday, August 26, 2005 3:22 PM
> 	To: pharmwaste@lists.dep.state.fl.us
> 	Subject: [Pharmwaste] general pharmaceutical waste
> questionnaire
> 
> 	 
> 
> 	does anyone out there have a general questionnaire that
> might
> apply across the board to pharmacies, hospitals, nursing
> homes,
> veterinarians, etc that one could plagiarize?  the only
> one i could find
> so far is one from the 
> 
> 	U.S. National Registry for Unused or Expired Medications
> 
> 	Questionnaire for Returned Medications by Individual
> Donor(c) 
> 	CRG Medical Foundation for Patient Safety (1/7/05) 
> 
> 	which applies to individuals only (and it's pretty
> comprehensive).  what's "out there" for the rest of the
> universe of
> folks that might really know what an NDC# is?   i could
> just modify the
> one above if no one has anything already created.
> 
> 	thanx for anything i can plagiarize for the great state
> of
> arkansas to discover what kind of a problem we might have
> with these
> unused/expired meds.  we've got a great pretreatment
> coordinator network
> in this state that wants to involved with the PSI
> program.  via their
> community outreach efforts, more info, ideas and guidance
> can be
> attained.  our biggest pharmacy chains are connected to
> walmart,
> walgreens, kroger and usa drug.  i'll make contact with
> them to see if
> they have, or heard of take back programs.
> 
> 	have a "cool" weekend, 
> 
> 	allen gilliam 
> 	adeq state pretreatment coordinator 
> 	501.682.0625 
> 	  
>