Příloha č. 4
Vzor listu evidenční knihy výroby přípravků, které obsahují návykové látky
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| | | | Datum | Množství | Skutečné | Odpad v g NL, | | Čitelný podpis |
| Pořadové | Účinná látka převzatá ze skladu | Číslo | předání | předané | výrobní | prekursorů, | | podpis |
| číslo +----------+----------+---------------+ vyrobené | do skladu | skladu, | ztráty | použitelný | Poznámka | pracovníka |
| zápisu | Datum | Množství | číslo | šarže | hotových | v počtu | v g NL, | k další výrobě | | provádějícího |
| | převzetí | v g | propouštěcího | | výrobků | balení | prekursorů | nebo | | zápis |
| | | | protokolu OTK | | | | | přepracování | | |
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