Charitable Pharmacy Destruction Log

For medications from charitable donation programs (Dispensary of Hope, Americares, etc.) — not the Wisconsin Drug Repository Program, which has its own Drug Repository Destruction Record tool.

Use this log for medications from charitable donation programs (Dispensary of Hope, Americares, etc.) that are NOT part of the Wisconsin Drug Repository Program — those should use the separate Drug Repository Destruction Record instead. Scan each item's barcode to auto-fill drug name, strength, NDC, lot, and expiration. Enter the quantity and unit (tablets, mL, etc.) for each item, fill in the destruction details once, sign, then generate the printable log. Retention requirements vary by program (e.g. Dispensary of Hope requires records be kept at least 3 years) — check your specific program's requirements.

Pharmacy / Facility Information

Source Program

Name – Pharmacy or Medical Facility

Street Address

City

State

Zip Code

Name – Person Destroying Drugs / Supplies

Date Destroyed

Scan Items

Hold the phone a few inches away so the barcode fills most of the frame

Drug / Medical Supply Information

Enter the number of individual units destroyed (tablets, capsules, mL, patches, etc.) and pick a unit — not the number of bottles/packages.

No items scanned yet

Signature

Date Signed

Signature – Person Destroying Drugs or Medical Supplies

Not signed