1. STANDARD PACKING LIST OBSTETRICS & PERIO THERAPY STUDY
TO BE COMPLETED BY THE SHIPPING CENTER
SHIPMENT NUMBER _________
PAGE ______ OF ______
DATE SHIPPED:
FROM:
TO:
PERSON COMPLETING:
DIRECTIONS:
(1) Fill in the box in the upper right corner. The shipment
number field should be filled in with the letter of your
city and the next number in sequence. For example,
Lexington’s 4th shipment would be L4.
(2) Itemize the contents of the shipment. If you need
more than 15 lines, use a second Standard Packing
list sheet. Leave the Received field (lower right)
blank. See Manual of Procedures, Sec. III.14.2.
(3) Enter special instructions concerning this shipment in
the Comments field.
NOTE: If a shipment has more than one Standard Packing
List page, the same Shipment Number is entered
on all sheets.
QUANTITY
DESCRIPTION
REC’D
PLEASE RETURN POSTCARD
Comments:
TO BE COMPLETED BY THE RECIPIENT
DATE RECEIVED: ______________________
CONDITION: __________________________
POSTCARD SENT: _____________________
PERSON: _____________________________
DCC USE ONLY: Beginning Sequence No: Ending Sequence No:
OPT Form V1 (1-1) Jun 03