---
title: Hospice Care Controlled Substance Loss Report Form Template | Paperform
description: Professional controlled substance loss report form for hospice care with chain of custody documentation, diversion investigation tracking, and state board compliance features.
url: "https://paperform.co/templates/hospice-care-controlled-substance-loss-report"
type: static
generatedAt: "2026-03-31T00:48:43.394Z"
---

[← Back to free form templates](/templates/)    ![Hospice Care Controlled Substance Loss Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-controlled-substance-loss-report.png)
    [Preview](https://_preview.paperform.co/ai-template/hospice-care-controlled-substance-loss-report) [Use this template for free](/create?ai-template=hospice-care-controlled-substance-loss-report)    [Reporting & Incident Forms](/templates/category/reporting/)[Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/)[Senior Care](/templates/industry/senior-care/)[Hospice & Palliative Care](/templates/industry/hospice/) [Nurse](/templates/role/nurse/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Compliance Officer](/templates/role/compliance-officer/)     About this free form template
### Comprehensive Controlled Substance Loss Reporting for Hospice Care Facilities

Managing controlled substances in hospice care requires meticulous documentation and immediate action when discrepancies occur. This **Hospice Care Controlled Substance Loss Report** template gives hospice administrators, nursing directors, and compliance officers a structured way to document medication losses, investigate potential diversion, and maintain the chain of custody records required by state pharmacy boards and the DEA.

#### Built for Regulatory Compliance and Internal Investigation

Hospice care providers face unique challenges in controlled substance management—medications are frequently transported to patient homes, administered by multiple caregivers, and managed across shifts. When losses occur, whether through theft, spillage, documentation error, or diversion, your response must be swift, thorough, and compliant.

This template captures every critical detail: the substance involved, quantity missing, last documented handling, witness accounts, and initial investigation findings. The form's conditional logic automatically adjusts questions based on loss type and suspected cause, ensuring you collect the right information without overwhelming your team with irrelevant fields.

#### Streamline Investigation and State Board Reporting

Once submitted, this form creates a complete incident record that can be reviewed by pharmacy directors, legal counsel, and compliance teams. Using **Stepper** (stepper.io), you can automatically route completed reports to your compliance officer for review, trigger follow-up investigation tasks, notify relevant department heads, and even pre-populate required fields for your state board filing—turning what's normally hours of manual work into an automated workflow.

The form includes sections for chain of custody reconstruction, employee statements, corrective action documentation, and state board notification tracking, giving you a single source of truth for the entire incident lifecycle.

#### Designed for Healthcare Compliance

This template is specifically built for hospice care, home health, and palliative care organizations that need to balance compassionate patient care with strict regulatory oversight. The professional design and clear structure help reduce stress during an already difficult situation, while the thorough documentation protects your organization and ensures transparency.

Whether you're a small hospice provider or a multi-site organization, this controlled substance loss report template helps you maintain compliance, investigate incidents systematically, and demonstrate your commitment to controlled substance security.

**Ready to strengthen your controlled substance management?** Start with Paperform's hospice care controlled substance loss report template and build confidence in your compliance processes.
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