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0 • <br /> Moses D. Elam,MD <br /> KAISER PERMANENTEo Physician-in-Chief <br /> Corwin N.Harper,MHA,FACHE <br /> Senior Vice President/Area Manager <br /> Central Valley Service Area <br /> PHARMECEUTICAL WASTE SEGREGATION <br /> Date/Time: APRIL-MAY 2011 <br /> Location: Manteca/Tracy Medical Center <br /> Department/ <br /> Print Name Sign Name Job Title' NUID Number! Date - <br /> _ _ Facility — --- <br /> LO+ Lcnm r r R morn BVS Aide A5934 14 1:V5/..\lantcca - <br /> 1 Jdic tilt nhnc� _ ,y - I I s\Idc <br /> E0574162 rA S/Alantec n <br /> I•'annn Zan:a:n. /Io-w 1 CVS Aide i QG(IIII( _ ! 1 ASlAh"tech l�. �'"/� <br /> Mal)0 l— I t l CVS Arlc I AS(Iracr <br /> Alrg_ucl ar l.durya C ,CSL= I vs vde C l/C233 ..__ 1 Srl racy .j�Jilzci/ <br /> -- — — <br /> j-1-111-11 <br /> 1-1er 1Mendora „_.� v_. - ENS Aide _ 6) �-}� rvsrrracv <br /> Antoncnc Qua a_ !�_._6),-I ' I VS Aide L°�'f)�-�t 1 A S 1 ac)' <br /> Darin Ile urea J P rvs viae 6'(18 Ya 7 <br /> ( EVS/M: it—, <br /> Deanna Alvarez. Dc I.Seerelarv' 1.723849 Trac) <br /> Course Instructor Name_ <br /> Course Instructor Signature: <br /> Course Instructor Title: [-:yam Sc.l��r�,Sores ra�c sof 3 <br /> 'Job descnplions are available for each Job Tile upon request <br /> Violation: HSC Section 18275 Pharm label/store —There are pharm sharps containers that <br /> lack label "Incineration Only" on the sides. These containers are located located in the <br /> Pharmacy, the CDA, SNF, the Soiled Utility Room in the Med Surg Unit, the Utility Room in <br /> the ED, and the Oxygen Storage Room. <br /> Corrective Statement: Take a photo of all sides and top of one correctly labeled <br /> pharmaceutical container and submit by 5/20/11. <br /> Page 4 of 5 <br /> Stockton Medical Office Manteca Medical Center Tracy Medical Offices Modesto Medical Offices <br /> 7373 West Lane,Stockton,CA 95210 1777 W.Yosemite Avenue,Manteca,CA 95337 2185 W.Grant Line Road,Tracy,CA 95377 Post Office Box 577680,Modesto,CA 95357 <br />