Sync template from atomicqms-style deployment

Forms/Compounding-Records/FRM-COMP-001-Oral-Suspension-Compounding-Log.md

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+# Pediatric Oral Suspension Compounding Log
+
+| Document ID | FRM-COMP-001 |
+|-------------|--------------|
+| Title | Oral Suspension Compounding Log |
+| Revision | 1.0 |
+| Effective Date | [DATE] |
+
+---
+
+## Patient/Prescription Information
+
+| Field | Value |
+|-------|-------|
+| Patient Name | ________________________________ |
+| Date of Birth | ________________________________ |
+| Prescription Number | ________________________________ |
+| Prescriber | ________________________________ |
+| Date Compounded | ________________________________ |
+
+## Formulation Information
+
+| Field | Value |
+|-------|-------|
+| Medication | ________________________________ |
+| Final Concentration | _________ mg/mL (or mcg/mL) |
+| Total Volume | _________ mL |
+| Flavor | _________ ☐ None |
+| Beyond-Use Date (BUD) | ________________________________ |
+| Storage Requirements | ☐ Refrigerate (2-8°C) ☐ Room temperature ☐ Protect from light |
+
+## Calculations
+
+### Dosage Form Used
+☐ Tablets
+☐ Capsules
+☐ Bulk powder
+
+**Product Details:**
+- Manufacturer: _______________________
+- Strength: _________ mg per tablet/capsule
+- NDC: _______________________
+- Lot Number: _______________________
+- Expiration Date: _______________________
+
+### Quantity Calculation
+
+**Quantity Needed:**
+```
+Desired concentration: _______ mg/mL
+Final volume needed: _______ mL
+Total drug needed: _______ mL × _______ mg/mL = _______ mg total
+```
+
+**Dosage Forms Required:**
+```
+_______ mg total ÷ _______ mg per unit = _______ units
+
+Round up to: _______ tablets/capsules
+(includes overage: ______ %)
+```
+
+**Verified by:** _________________ (Second pharmacist initials)
+
+## Ingredients
+
+| Ingredient | Manufacturer/Brand | Lot Number | Expiration Date | Quantity Used |
+|------------|-------------------|------------|-----------------|---------------|
+| [Drug name] | _______________ | __________ | ______________ | ______ units |
+| Suspending vehicle | _______________ | __________ | ______________ | ______ mL |
+| Sweetening agent | _______________ | __________ | ______________ | ______ mL |
+| Flavoring (if used) | _______________ | __________ | ______________ | ______ mL |
+| Other: __________ | _______________ | __________ | ______________ | __________ |
+
+## Compounding Procedure
+
+### Preparation Checklist
+☐ Hand hygiene performed
+☐ Appropriate garbing (lab coat, gloves)
+☐ Work area cleaned and disinfected
+☐ Equipment cleaned and ready
+☐ All ingredients verified and gathered
+
+### Compounding Steps Completed
+
+☐ **Step 1:** Counted and verified ______ tablets/capsules
+☐ **Step 2:** Crushed tablets to fine powder / Emptied capsule contents
+☐ **Step 3:** Triturated to uniform powder
+☐ **Step 4:** Added small portion of vehicle, mixed to smooth paste
+☐ **Step 5:** Used geometric dilution, added vehicle in portions
+☐ **Step 6:** Transferred to graduated cylinder
+☐ **Step 7:** Rinsed mortar with vehicle
+☐ **Step 8:** Brought to final volume: _______ mL
+☐ **Step 9:** Added flavor (if applicable): _______ mL
+☐ **Step 10:** Transferred to final container
+☐ **Step 11:** Shook thoroughly for 30 seconds
+
+## Quality Control
+
+### Visual Inspection
+☐ Uniform suspension (no large particles)
+☐ Appropriate color
+☐ Smooth consistency
+☐ No visible contamination
+☐ Suspends well when shaken
+
+### Volume Verification
+- Target volume: _______ mL
+- Actual volume: _______ mL
+- Within acceptable range (±5%): ☐ Yes ☐ No
+
+### Concentration Verification
+```
+Total drug: _______ mg
+Final volume: _______ mL
+Concentration: _______ mg ÷ _______ mL = _______ mg/mL
+```
+☐ Matches intended concentration
+
+**Independent calculation by:** _________________ (Pharmacist initials)
+
+## Beyond-Use Date Determination
+
+**Stability Reference:**
+☐ Published study (citation): _________________________________
+☐ USP <795> general guidance: 14 days refrigerated / 30 days room temp
+☐ Manufacturer information
+☐ Trissel's Stability Reference
+☐ Other: _________________________________
+
+**BUD Assigned:** _________________________________
+
+**Rationale:** ___________________________________________________
+
+## Labeling
+
+☐ Patient name and date of birth
+☐ Medication name and concentration
+☐ "SHAKE WELL BEFORE EACH USE"
+☐ Directions for use
+☐ Beyond-use date
+☐ Storage instructions
+☐ "For Oral Use Only"
+☐ Flavor (if added)
+☐ Pharmacist initials
+☐ Compounding date
+☐ Auxiliary labels (if applicable)
+
+**Oral syringe provided:** ☐ Yes (size: _____ mL) ☐ No ☐ N/A
+
+## Final Verification
+
+### Pharmacist Final Check
+☐ Correct medication and strength
+☐ Accurate calculations verified
+☐ Appropriate concentration for patient
+☐ Correct labeling
+☐ BUD appropriate and documented
+☐ Storage instructions clear
+☐ Quality checks passed
+
+**Verifying Pharmacist:**
+- Name: _________________________
+- License #: _________________________
+- Signature: _________________________
+- Date/Time: _________________________
+
+## Counseling Points Provided
+
+☐ Shake well before each use
+☐ Use oral syringe for accurate dosing
+☐ Storage requirements explained
+☐ Beyond-use date explained
+☐ Administration technique demonstrated
+☐ Side effects discussed
+☐ Importance of completing therapy
+
+**Counseled by:** __________________ Date/Time: __________
+
+## Documentation
+
+### Compounded by
+- Technician/Pharmacist Name: _________________________
+- Signature: _________________________
+- Date/Time: _________________________
+
+### Checked by
+- Pharmacist Name: _________________________
+- License #: _________________________
+- Signature: _________________________
+- Date/Time: _________________________
+
+## Cleanup
+
+☐ All equipment washed and dried
+☐ Work surface disinfected
+☐ Waste disposed of appropriately
+☐ Ingredients returned to storage
+
+**Cleaned by:** __________________ Date/Time: __________
+
+## Notes/Deviations
+
+_____________________________________________________________________
+_____________________________________________________________________
+_____________________________________________________________________
+
+---
+
+## For Pharmacy Records
+
+**Record Retention:** Per state board requirements (minimum 3 years)
+
+**Filed in:** ☐ Compounding logs ☐ Patient profile ☐ Both
+
+**Log reviewed by:** ______________ Date: ________
+
+---
+
+*Form FRM-COMP-001 Rev 1.0 - Pediatric Pharmacy Compounding*

Forms/Dose-Calculation/FRM-DOSE-001-Pediatric-Dose-Calculation-Worksheet.md

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+# Pediatric Dose Calculation Worksheet
+
+| Document ID | FRM-DOSE-001 |
+|-------------|--------------|
+| Title | Pediatric Dose Calculation Worksheet |
+| Revision | 1.0 |
+| Effective Date | [DATE] |
+
+---
+
+## Patient Information
+
+| Field | Value |
+|-------|-------|
+| Patient Name | _________________________ |
+| Date of Birth | _________________________ |
+| Age | _________________________ |
+| Medical Record # | _________________________ |
+| Date/Time of Calculation | _________________________ |
+
+## Patient Measurements
+
+| Measurement | Value | Date/Time Obtained | Source |
+|-------------|-------|-------------------|---------|
+| Weight (kg) | _________ kg | _____________ | ☐ Inpatient chart ☐ Outpatient ☐ Parent-reported |
+| Height (cm) | _________ cm | _____________ | ☐ Inpatient chart ☐ Outpatient ☐ Parent-reported |
+| BSA (m²) | _________ m² | _____________ | Calculation method: ☐ Mosteller ☐ DuBois ☐ Other: _____ |
+
+**Weight Status:**
+☐ Current per policy (specify timeframe): _____________
+☐ Needs update - contacted: ☐ Nurse ☐ Clinic ☐ Parent
+
+## Medication Order
+
+| Field | Value |
+|-------|-------|
+| Medication | _________________________________________ |
+| Indication | _________________________________________ |
+| Ordered Dose | _________________________________________ |
+| Dosing Frequency | _________________________________________ |
+| Route | _________________________________________ |
+| Prescriber | _________________________________________ |
+
+## Dose Calculation
+
+### Dosing Type
+☐ Weight-based (mg/kg)
+☐ BSA-based (mg/m²)
+☐ Fixed dose (no calculation needed)
+☐ Other: _______________
+
+### Calculation Method
+
+**If Weight-Based:**
+```
+Dose ordered: ________ mg/kg/dose  OR  ________ mg/kg/day
+
+Calculation:
+_______ kg × _______ mg/kg/dose = _______ mg/dose
+
+OR (if total daily dose):
+_______ kg × _______ mg/kg/day = _______ mg/day
+_______ mg/day ÷ _______ doses/day = _______ mg/dose
+```
+
+**If BSA-Based:**
+```
+Dose ordered: ________ mg/m²/dose  OR  ________ mg/m²/day
+
+Calculation:
+_______ m² × _______ mg/m²/dose = _______ mg/dose
+
+OR (if total daily dose):
+_______ m² × _______ mg/m²/day = _______ mg/day
+_______ mg/day ÷ _______ doses/day = _______ mg/dose
+```
+
+### Final Dose
+**Calculated Dose:** __________ mg/dose
+
+**Rounded/Dispensed Dose:** __________ mg/dose
+
+**Reason for rounding (if applicable):**
+☐ Available dosage form
+☐ Measurable quantity
+☐ Patient-specific factors
+☐ Other: _______________________
+
+## Dose Verification
+
+### Reference Check
+**Reference Source(s):** ☐ Lexicomp ☐ Micromedex ☐ Harriet Lane ☐ Neofax ☐ Other: __________
+
+**Recommended Dosing Range for Indication:**
+- Minimum: __________ mg/kg/dose (or mg/m²/dose)
+- Maximum: __________ mg/kg/dose (or mg/m²/dose)
+- Frequency: __________
+
+**Calculated dose within range?** ☐ Yes ☐ No
+
+**If NO, action taken:**
+☐ Clarified with prescriber (see notes)
+☐ Clinical justification documented
+☐ Order discontinued
+☐ Other: _______________________
+
+### Maximum Dose Check
+**Maximum dose per dose:** __________ mg (if applicable)
+**Maximum dose per day:** __________ mg (if applicable)
+
+**Does calculated dose exceed maximum?** ☐ Yes ☐ No ☐ N/A
+
+**If YES, dispensed dose:** __________ mg (maximum dose applied)
+
+### Age-Specific Considerations
+☐ Dose appropriate for patient age
+☐ Formulation appropriate for patient age/development
+☐ No age-specific contraindications
+☐ Age-specific warnings reviewed
+
+### Special Populations
+☐ Renal adjustment needed - CrCl: _____ mL/min - Adjusted dose: _____ mg
+☐ Hepatic adjustment needed - Severity: _____ - Adjusted dose: _____ mg
+☐ Obese (>95th percentile) - Used: ☐ Actual weight ☐ Ideal weight ☐ Adjusted weight
+☐ Premature infant - Gestational age: _____ weeks - PMA: _____ weeks
+
+## High-Alert Medication Independent Double-Check
+
+**Is this a high-alert medication?** ☐ Yes ☐ No
+
+**If YES, complete independent verification:**
+
+### First Pharmacist Calculation
+- Pharmacist Name: _________________________ Date/Time: _________
+- Calculated Dose: __________ mg/dose
+- Within Range: ☐ Yes ☐ No
+- Signature: _________________________
+
+### Second Pharmacist Independent Calculation
+- Pharmacist Name: _________________________ Date/Time: _________
+- Calculated Dose: __________ mg/dose
+- Within Range: ☐ Yes ☐ No
+- Signature: _________________________
+
+### Verification Result
+☐ Calculations match - Proceed
+☐ Discrepancy identified - see resolution below
+
+**Discrepancy Resolution:**
+_________________________________________________________________
+_________________________________________________________________
+
+## Final Verification and Approval
+
+**Final Dose to Dispense:** __________ mg per dose
+**Quantity to Dispense:** __________ (doses/volume)
+**Dosing Instructions:** _______________________________________________
+
+**Off-Label Use?** ☐ Yes ☐ No
+**If YES, clinical justification:** _____________________________________
+
+**Pharmacist Final Verification:**
+- Name: _________________________
+- License #: _________________________
+- Signature: _________________________
+- Date/Time: _________________________
+
+## Notes/Comments
+
+_____________________________________________________________________
+_____________________________________________________________________
+_____________________________________________________________________
+_____________________________________________________________________
+
+---
+
+## Disposition
+☐ Dose verified and approved - proceed with dispensing
+☐ Contacted prescriber for clarification
+☐ Order modified per prescriber
+☐ Order discontinued
+
+---
+
+**For Pharmacy Use Only**
+
+Calculation reviewed by: _____________ Date: ________ Time: ________
+
+Filed in: ☐ Patient chart ☐ Pharmacy records ☐ Both
+
+---
+
+*Form FRM-DOSE-001 Rev 1.0 - Pediatric Pharmacy*

Forms/Training/FRM-004-Pediatric-Pharmacy-Competency-Assessment.md

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+# Pediatric Pharmacy Competency Assessment
+
+| Document ID | FRM-004 |
+|-------------|---------|
+| Title | Pediatric Pharmacy Competency Assessment |
+| Revision | 1.0 |
+| Effective Date | [DATE] |
+
+---
+
+## Employee Information
+
+| Field | Value |
+|-------|-------|
+| Employee Name | ________________________________ |
+| Position | ☐ Pediatric Pharmacist ☐ Pharmacy Technician ☐ Pharmacy Resident ☐ Student |
+| License/Registration # | ________________________________ |
+| Hire Date | ________________________________ |
+| Assessment Date | ________________________________ |
+| Assessment Type | ☐ Initial ☐ Annual ☐ Triggered ☐ Return from leave |
+
+## Assessor Information
+
+| Field | Value |
+|-------|-------|
+| Assessor Name | ________________________________ |
+| Title | ________________________________ |
+| License # | ________________________________ |
+| Date | ________________________________ |
+
+---
+
+## Part 1: Pediatric Dosing Calculations
+
+**Instructions:** Complete all calculations. 100% accuracy required. Show all work.
+
+### Scenario 1: Weight-Based Dosing
+
+**Patient:** 3-year-old male, weight 14.2 kg
+
+**Order:** Amoxicillin 40 mg/kg/day divided every 8 hours
+
+**Questions:**
+1. Calculate total daily dose: ____________ mg/day
+2. Calculate individual dose: ____________ mg per dose
+3. Is this dose within the recommended range for amoxicillin (20-90 mg/kg/day)? ☐ Yes ☐ No
+
+**Work shown:**
+_____________________________________________________________________
+_____________________________________________________________________
+
+### Scenario 2: Maximum Dose Application
+
+**Patient:** 12-year-old female, weight 52 kg
+
+**Order:** Ondansetron 0.15 mg/kg IV for nausea
+
+**Questions:**
+1. Calculate dose based on weight: ____________ mg
+2. Maximum dose for ondansetron is 16 mg. What dose would you dispense? ____________ mg
+3. Why? _____________________________________________________________
+
+**Work shown:**
+_____________________________________________________________________
+_____________________________________________________________________
+
+### Scenario 3: BSA-Based Dosing
+
+**Patient:** 7-year-old male, weight 25 kg, height 120 cm, BSA 0.92 m²
+
+**Order:** Vincristine 1.5 mg/m² IV (chemotherapy)
+
+**Questions:**
+1. Calculate dose: ____________ mg
+2. This dose will be independently verified by a second pharmacist because:
+   ☐ High-alert medication
+   ☐ Chemotherapy
+   ☐ Both
+   ☐ Neither
+
+**Work shown:**
+_____________________________________________________________________
+_____________________________________________________________________
+
+### Scenario 4: Neonatal Dosing
+
+**Patient:** Premature infant, gestational age 32 weeks, postnatal age 5 days, weight 1.8 kg
+
+**Order:** Gentamicin 4 mg/kg/dose IV every 24 hours
+
+**Questions:**
+1. Calculate dose: ____________ mg
+2. For a 10 mg/mL concentration, what volume is needed? ____________ mL
+3. Does the extended interval (q24h) make sense for this patient? ☐ Yes ☐ No
+   Why? ____________________________________________________________
+
+**Work shown:**
+_____________________________________________________________________
+_____________________________________________________________________
+
+### Scenario 5: Dilution Calculation
+
+**Patient:** 6-month-old infant, weight 7.5 kg
+
+**Order:** Digoxin 10 mcg/kg/day divided BID
+
+**Available:** Digoxin elixir 50 mcg/mL
+
+**Questions:**
+1. Total daily dose: ____________ mcg/day
+2. Individual dose: ____________ mcg per dose
+3. Volume to administer per dose: ____________ mL
+
+**Work shown:**
+_____________________________________________________________________
+_____________________________________________________________________
+
+---
+
+## Part 2: Knowledge Assessment
+
+**Instructions:** Answer all questions.
+
+### 1. Pediatric Age Categories
+Match the age to the correct category:
+
+| Age | Category |
+|-----|----------|
+| 2 months | ☐ Neonate ☐ Infant ☐ Child ☐ Adolescent |
+| 15 days | ☐ Neonate ☐ Infant ☐ Child ☐ Adolescent |
+| 5 years | ☐ Neonate ☐ Infant ☐ Child ☐ Adolescent |
+| 16 years | ☐ Neonate ☐ Infant ☐ Child ☐ Adolescent |
+
+### 2. High-Alert Medications
+List 5 high-alert medications in pediatrics that require independent double-check:
+
+1. _________________________________
+2. _________________________________
+3. _________________________________
+4. _________________________________
+5. _________________________________
+
+### 3. Weight Currency
+What is the maximum age of weight for the following patient types?
+
+- NICU/critical care inpatients: ☐ 24 hours ☐ 72 hours ☐ 1 week
+- General inpatients: ☐ 24 hours ☐ 72 hours ☐ 1 week
+- Outpatient infants (<1 year): ☐ 1 month ☐ 3 months ☐ 6 months
+
+### 4. USP Standards
+Which USP chapter covers non-sterile compounding?
+☐ USP <795>
+☐ USP <797>
+☐ USP <800>
+
+Which USP chapter covers sterile compounding?
+☐ USP <795>
+☐ USP <797>
+☐ USP <800>
+
+### 5. Off-Label Use
+Approximately what percentage of medications used in pediatrics are off-label?
+☐ <10%
+☐ 25-30%
+☐ 50-70%
+☐ >90%
+
+---
+
+## Part 3: Practical Skills Assessment
+
+**Instructions:** Assessor observes and evaluates performance.
+
+### Skill 1: Order Verification and Dosing
+
+**Task:** Process a pediatric medication order from start to finish
+
+| Step | Satisfactory | Needs Improvement | Not Observed |
+|------|--------------|-------------------|--------------|
+| Verifies patient identity (name, DOB, MRN) | ☐ | ☐ | ☐ |
+| Obtains current patient weight | ☐ | ☐ | ☐ |
+| Verifies weight is current per policy | ☐ | ☐ | ☐ |
+| Calculates dose accurately | ☐ | ☐ | ☐ |
+| Checks dose against reference range | ☐ | ☐ | ☐ |
+| Verifies maximum dose not exceeded | ☐ | ☐ | ☐ |
+| Documents calculation appropriately | ☐ | ☐ | ☐ |
+| Obtains independent verification if required | ☐ | ☐ | ☐ |
+| Selects age-appropriate formulation | ☐ | ☐ | ☐ |
+
+**Overall Performance:** ☐ Competent ☐ Needs additional training
+
+**Comments:** ___________________________________________________________
+
+### Skill 2: Compounding Oral Suspension (if applicable)
+
+**Task:** Compound an oral suspension from tablets following SOP
+
+| Step | Satisfactory | Needs Improvement | Not Observed |
+|------|--------------|-------------------|--------------|
+| Performs calculations correctly | ☐ | ☐ | ☐ |
+| Prepares workspace appropriately | ☐ | ☐ | ☐ |
+| Uses proper hand hygiene and garbing | ☐ | ☐ | ☐ |
+| Crushes tablets to fine powder | ☐ | ☐ | ☐ |
+| Uses geometric dilution correctly | ☐ | ☐ | ☐ |
+| Achieves smooth, uniform suspension | ☐ | ☐ | ☐ |
+| Brings to accurate final volume | ☐ | ☐ | ☐ |
+| Labels correctly with all required info | ☐ | ☐ | ☐ |
+| Assigns appropriate BUD | ☐ | ☐ | ☐ |
+| Documents in compounding log | ☐ | ☐ | ☐ |
+
+**Overall Performance:** ☐ Competent ☐ Needs additional training
+
+**Comments:** ___________________________________________________________
+
+### Skill 3: Patient/Family Counseling
+
+**Task:** Counsel parent/guardian on pediatric medication
+
+| Step | Satisfactory | Needs Improvement | Not Observed |
+|------|--------------|-------------------|--------------|
+| Introduces self and confirms patient | ☐ | ☐ | ☐ |
+| Uses age-appropriate language | ☐ | ☐ | ☐ |
+| Explains indication for medication | ☐ | ☐ | ☐ |
+| Demonstrates dose measurement | ☐ | ☐ | ☐ |
+| Emphasizes importance of accurate dosing | ☐ | ☐ | ☐ |
+| Explains administration technique | ☐ | ☐ | ☐ |
+| Reviews storage requirements | ☐ | ☐ | ☐ |
+| Discusses common side effects | ☐ | ☐ | ☐ |
+| Emphasizes completing full course | ☐ | ☐ | ☐ |
+| Provides opportunity for questions | ☐ | ☐ | ☐ |
+
+**Overall Performance:** ☐ Competent ☐ Needs additional training
+
+**Comments:** ___________________________________________________________
+
+---
+
+## Part 4: Scenario-Based Assessment
+
+### Scenario: Potential Error Identification
+
+**Situation:** A 2-month-old infant (4.5 kg) has an order for gentamicin 15 mg IV every 8 hours.
+
+**Usual neonatal dosing:** 4-5 mg/kg/dose every 24-48 hours (extended interval)
+
+**Questions:**
+
+1. Do you see any concerns with this order? ☐ Yes ☐ No
+
+2. If yes, what are they?
+   _________________________________________________________________
+   _________________________________________________________________
+
+3. What action would you take?
+   ☐ Dispense as ordered
+   ☐ Contact prescriber for clarification
+   ☐ Refuse to fill
+   ☐ Other: __________
+
+4. Calculate what the dose should likely be:
+   _________________________________________________________________
+
+**Assessor evaluation:**
+☐ Correctly identified potential error
+☐ Appropriate action plan
+☐ Accurate alternative dose calculation
+
+---
+
+## Assessment Results
+
+### Part 1: Dosing Calculations
+- Scenarios correct: ______ / 5
+- **Required: 5/5 (100%)**
+- Result: ☐ **PASS** ☐ **FAIL**
+
+### Part 2: Knowledge Assessment
+- Questions correct: ______ / 9
+- **Required: 7/9 (78%)**
+- Result: ☐ **PASS** ☐ **FAIL**
+
+### Part 3: Practical Skills
+- Skills demonstrated competently: ______ / 3
+- **Required: 3/3**
+- Result: ☐ **PASS** ☐ **FAIL**
+
+### Part 4: Scenario Assessment
+- Result: ☐ **PASS** ☐ **FAIL**
+
+---
+
+## Overall Assessment Result
+
+☐ **COMPETENT** - All sections passed, authorized for independent practice
+
+☐ **NEEDS REMEDIATION** - See below for areas needing improvement
+
+☐ **NOT COMPETENT** - Requires additional training before reassessment
+
+### Areas Needing Improvement:
+_____________________________________________________________________
+_____________________________________________________________________
+_____________________________________________________________________
+
+### Remediation Plan:
+_____________________________________________________________________
+_____________________________________________________________________
+_____________________________________________________________________
+
+**Reassessment Date:** ____________________
+
+---
+
+## Signatures
+
+### Employee
+I have completed this competency assessment to the best of my ability.
+
+**Signature:** _________________________ **Date:** __________
+
+### Assessor
+I have assessed this employee's competency in pediatric pharmacy practice.
+
+**Signature:** _________________________ **Date:** __________
+
+**Printed Name:** _________________________ **License #:** __________
+
+### Pharmacy Manager (if remediation required)
+**Signature:** _________________________ **Date:** __________
+
+---
+
+**Record Retention:** Maintained in employee file per regulatory requirements
+
+**Next Assessment Due:** ____________________
+
+---
+
+*Form FRM-004 Rev 1.0 - Pediatric Pharmacy*