Standards of Professional Practice Training Acknowledgement Receipt - IPPC Pharmacy
Please complete this form to acknowledge receipt and understanding of the Standards of Professional Practice training materials.
Pharmacy Personnel Printed Name
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Title
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Training Conducted On
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Training
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Pharmacy Code of Ethics
Patient Bill of Rights and Responsibilities
Pharmacy Mission Statement
Pharmacy Scope of Services
Job Description
Employee Handbook
Pharmacy Work Environment
Cultural Awareness
Fire and Safety
Other (Describe below)
Other Training Completed
I acknowledge that I have received, read, and understand the Standards of Professional Practice training materials as listed above. I agree to adhere to the policies, procedures, and standards outlined therein. I understand that failure to comply may result in disciplinary action, up to and including termination of employment.
Pharmacy Personnel Signature
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Trainer Name
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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