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-- Select Facility Type --
Hospital
Assisted Living Facility
Skilled Nursing Facility
Clinic
Pharmacy
Other
-- In how many areas throughout your facility will a Rx Waste Container be placed? --
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
More than 15
-- Estimated # of 8-Gal Rx Waste Containers used --
1 per year
1 every 6 months
1 every 3 months
1 every 2 months
1 per month
2 per month
3 per month
4 per month
5 per month
6 per month
7 per month
8 per month
9 per month
10 per month
More than 10 per month
-- In how many areas will a secure Controlled Substance Container be placed? --
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
More than 15
-- Estimated # of 1-Gal Controlled Substance Containers used --
1 per year
1 every 6 months
1 every 3 months
1 every 2 months
1 per month
2 per month
3 per month
4 per month
5 per month
6 per month
7 per month
8 per month
9 per month
10 per month
More than 10 per month
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