Sample Passport

Sample Passport: What a patient sees when they scan the label.

Order RX-60412. Every firm fictional.

A complete Evidence Passport for one order.

Built on the sample workspace: the lab's results beside the limits printed on the report, each ingredient traced to its own lot, the people behind the record, and a fingerprint anyone can recompute. It describes the paperwork, never the medicine.

Sample record: an Evidence Passport for order RX-60412, batch CB-2026-1007-01. Sample data; every firm and person is fictional.

The pharmacy first. Then the medicine, its dates and who released it.

What does the Passport say first?

The pharmacy that dispensed it, then the preparation and the order, then facts a patient can read in seconds.

Dispensed by
Brennick Compounding
Preparation
Cyanocobalamin 1,000 mcg/mL
Batch and order
CB-2026-1007-01 · order RX-60412
Beyond-use date
November 21, 2026, with a note to confirm with the pharmacy which date applies
Reviewed and released by
Dana Reyes, PharmD, on October 7, 2026
Strength
1,000 mcg/mL, as recorded in the certificate fields
Certificate lines
5 reported
Notices
None on record
Recall notices
“Be told if this batch is ever recalled.” An email address is all it asks for.

Each quick fact says what it does not settle.

The date line asks the patient to confirm with the pharmacy whether a date is an expiry, a retest date or the beyond-use date of the dispensed preparation, because a certificate's date and a label's date can differ for good reasons.

The sample Passport for order RX-60412: the dispensing pharmacy first, the preparation, its beyond-use date, who reviewed and released it, and the recall sign-up
The Passport a patient opens by scanning the vial. Sample data: every firm and person is fictional.

Each result beside its printed limit.

What did the lab report?

Each result beside the limit printed on the same report, and whether one sits inside the other.

TestResultLimit printed on the reportOn the Passport
Assay (HPLC)101.4%90.0 to 110.0%Within the printed limit
SterilitySample sent October 7, result due October 21No growthNot reported yet
Bacterial endotoxinsLess than 10 EU/mLNMT 400 EU/mLWithin the printed limit
pH5.64.5 to 7.0Within the printed limit
AppearanceClear, dark red solutionNo limit printedNot compared

Appearance has no limit printed beside it, so the Passport says not compared rather than inventing one. A sterility test takes 14 days, so its result is not reported yet; the beyond-use date was set to hold without it. If two certificate fields record different values for the same result, the line reads Values differ. Ask your pharmacy.

Under the results, the Passport lists the remaining certificate fields from a fixed allowlist of 13: strength, sample amount tested, assay or purity, sterility, bacterial endotoxin, pH, appearance, particulate matter, test method, testing laboratory, the date on the certificate, the date recorded as expiry, and the manufacturer.

Nothing outside the allowlist reaches a patient.

On this page each result is compared with the limit printed on its own report.

The pharmacy's review goes further, computing the endotoxin limit from the dose under USP <85> and checking the substance against FDA's records; that work stays in the workspace, and the Passport says only what paperwork was checked.

Every ingredient, with its own lot. And its own results.

What went into it?

For a compounded preparation, every ingredient with its lot, its supplier, whether a person reviewed it, and that ingredient's own lab results.

IngredientLot and supplierReviewed by a personFrom its certificate
Cyanocobalamin USPBM-5520 · Brookmere API Supply, made by Halden Fine ChemicalsYes, October 6, 2026Assay 99.1% against 96.0 to 102.0%
Sodium Chloride USPNC-3318 · Aurora Pharma SupplyYes, October 2, 2026Assay 99.8% against 99.0 to 100.5%
Benzyl Alcohol NFBA-2041 · Vellora PharmachemYes, September 29, 2026Assay 99.6% against 97.0 to 100.5%

Behind the line for lot BM-5520 sits its history in the pharmacy's workspace. Its first certificate named the seller and not the maker, so the lot was held.

On October 6 a corrected certificate named Halden Fine Chemicals, a person reviewed the lot, and it cleared. A preparation made from a held ingredient lot is held with it, so no Passport issues on top of one.

The ingredients of batch CB-2026-1007-01, each traced to its own lot and supplier, reviewed by a person, with each lot's own assay
Each ingredient line reads from the compounding record and that ingredient's own certificate.

Every hand, by role. With an honest caveat under them.

Who handled it?

The roles the paperwork names, in order, with an honest caveat printed under them.

  1. Manufacturer: Halden Fine Chemicals

    Named on the corrected certificate and found in FDA's establishment registry as registered to manufacture, not only to relabel or repack.

  2. Supplier: Brookmere API Supply

    Sold lot BM-5520 and keeps a supplier file at the pharmacy, with every element dated.

  3. Compounded and released: Brennick Compounding

    Batch CB-2026-1007-01, released by Dana Reyes, PharmD on October 7, 2026, after a person's review of every ingredient lot.

  4. Received: Linden Row Clinic

    Received by shipment code on October 9, 2026. Shown where the clinic uses Custody, the shared record of who held each unit.

  5. Administered

    October 12, 2026, against the clinic's own reference. No patient name is recorded anywhere.

Under the list the Passport prints:

These are recorded roles, not proof of every physical handoff.Printed on every Passport, under its roles

Check it yourself. The fingerprint is recomputed in your browser.

How can anyone check the record is genuine?

By recomputing its fingerprint in their own browser, from the fields on the screen.

The Passport carries a SHA-256 fingerprint of its visible fields. A button labelled Verify this yourself recomputes it locally and shows exactly what was hashed, in order.

Change any field and the fingerprint changes; a mismatch tells the reader not to rely on that copy and to open the live link instead.

The vial's Seal, the serialized QR on its label, carries a serial such as VS-7Q2K-8HMN, drawn from a 30-symbol alphabet with the look-alike characters removed, and a QR code to the same public page.

A recall a person declares appears on that page, attributed to whoever declared it, and a patient who saved the vial with an email address is told.

The Passport's SHA-256 fingerprint recomputed in the reader's own browser from the fields on screen, and matching
The fingerprint is recomputed on the reader's device. Nothing is sent anywhere to check it.

One record, two depths. The patient's view is narrower by design.

What does the pharmacy see that a patient never does?

The same record at two depths. The patient's view is narrower by design.

In the pharmacy's workspaceOn the patient's Passport
The verdictOne of four headings, with every check and the standard behind itNo score, band or posture word
FindingsEach cited to its page and line, quoted word for wordNot shown. The record says what paperwork was checked
The certificateEvery value read, with the text as read beside the review13 allowlisted fields, each beside its printed limit
PeopleEvery reviewer, signature and reasonThe roles the paperwork names
Supplier notesInternal notes and correspondence with the supplierNever shown
The patientAn order reference that looks like patient text is refusedNo name, chart or prescription

The patient view tells the same nine steps from maker to patient in plain words. It says what paperwork was checked, and never that the medicine was tested.

Documentation only.

What does this record not establish?

  • Documentation only. No product was tested and no supplier was approved.
  • Absence of a public-source match is not proof of absence.
  • A date on the record is documentary evidence. The pharmacy confirms which date applies to the dispensed preparation.
  • The order, batch, firms, lots and people on this page are sample data. They describe the shape of a record, not a shipment anyone received.
Next

Issue Passports from your own lots.

One Evidence Passport per dispensed order, issued only from a lot a named person has reviewed, with a Seal on every unit. Scans and reprints are free.