Controlled Substance Tracker

Controlled Substance Tracker Template

Editable Word Template | Instant Digital Download | For RCFE, ARF, Assisted Living & Residential Care Facilities

Keep controlled medication documentation organized with the Controlled Substance Tracker Template from RCCS Digital Solutions by Rosenthal Community Care Services.

This editable, one-page landscape template is designed to help residential care providers track controlled substance administration using a clear 60-to-1 count layout. It includes space for resident information, medication details, prescription information, dosage directions, date and time administered, dose given, and staff initials or signature.

This form is ideal for care homes that need a simple, professional, and printable controlled substance count sheet for medication binders, resident files, pharmacy records, and facility documentation systems.

What’s Included

This Controlled Substance Tracker includes sections for:

• Resident name
• Date of birth
• Room number
• Allergies
• Medication name
• Prescription number
• Pharmacy
• Quantity filled
• Date received
• Dosage
• Frequency / directions
• Prescriber / physician
• 60-to-1 controlled substance count rows
• Date administered
• Time administered
• Dose given
• Staff initials / signature

Great For

• RCFE facilities
• ARF facilities
• Assisted living homes
• Residential care homes
• Senior care facilities
• Adult residential facilities
• Medication documentation binders
• Controlled substance count sheets
• Narcotic count records
• Caregiver medication administration tracking
• Resident medication records
• Facility compliance organization

Product Features

• Editable Word document
• Printable one-page landscape format
• 60-to-1 count layout
• Clean and professional design
• Easy to customize with your own facility logo or letterhead
• Simple medication count and administration tracking
• Designed for facility use
• Instant digital download
• No physical product will be shipped

Important Disclaimer

This template is provided for general operational and documentation support only. It does not replace licensing, legal, medical, pharmacy, or regulatory guidance. Facility operators are responsible for verifying compliance with applicable laws, regulations, physician orders, pharmacy instructions, and facility policies.

Digital Download Only. No physical item will be shipped.