Get the free Act 114 Prescriber Consent Form

Name: Fillable Online Act 114 Prescriber Consent Form Fax Email Print - pdfFiller
Brand: pdfFiller
Rating: 4.3 (28 reviews)

Get Form

Show details

Prescriber Consent Form (Rev. 12/14) The Longer Care Patient Access to Pharmaceuticals Act, (P.L., No. 114) allows eligible patients in long term care facilities, assisted living residences and personal

We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign act 114 prescriber consent

Edit your act 114 prescriber consent form online

Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.

Add your legally-binding signature

Draw or type your signature, upload a signature image, or capture it with your digital camera.

Share your form instantly

Email, fax, or share your act 114 prescriber consent form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing act 114 prescriber consent online

Ease of Setup

pdfFiller User Ratings on G2

Ease of Use

pdfFiller User Ratings on G2

Use the instructions below to start using our professional PDF editor:

1

Log in to your account. Click on Start Free Trial and register a profile if you don't have one.

2

Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.

3

Edit act 114 prescriber consent. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.

4

Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.

It's easier to work with documents with pdfFiller than you could have ever thought. Sign up for a free account to view.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.

Learn more about security & compliance

Fill form : Try Risk Free

Rate the form

4.3

Satisfied

28 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

What is act 114 prescriber consent?

Act 114 prescriber consent is a form required for prescribers to grant or deny consent for their information to be included in the Pennsylvania Prescription Drug Monitoring Program (PA PDMP).

Who is required to file act 114 prescriber consent?

All prescribers who are licensed and actively prescribing controlled substances in Pennsylvania are required to file act 114 prescriber consent.

How to fill out act 114 prescriber consent?

Prescribers can fill out act 114 prescriber consent online by logging into the PA PDMP website and completing the necessary information.

What is the purpose of act 114 prescriber consent?

The purpose of act 114 prescriber consent is to allow prescribers to control whether their prescribing information is accessed by other healthcare providers through the PA PDMP.

What information must be reported on act 114 prescriber consent?

Act 114 prescriber consent requires prescribers to provide their name, address, contact information, license number, and consent status.

How can I edit act 114 prescriber consent from Google Drive?

Simplify your document workflows and create fillable forms right in Google Drive by integrating pdfFiller with Google Docs. The integration will allow you to create, modify, and eSign documents, including act 114 prescriber consent, without leaving Google Drive. Add pdfFiller’s functionalities to Google Drive and manage your paperwork more efficiently on any internet-connected device.

How do I complete act 114 prescriber consent online?

pdfFiller has made filling out and eSigning act 114 prescriber consent easy. The solution is equipped with a set of features that enable you to edit and rearrange PDF content, add fillable fields, and eSign the document. Start a free trial to explore all the capabilities of pdfFiller, the ultimate document editing solution.

Can I create an eSignature for the act 114 prescriber consent in Gmail?

You may quickly make your eSignature using pdfFiller and then eSign your act 114 prescriber consent right from your mailbox using pdfFiller's Gmail add-on. Please keep in mind that in order to preserve your signatures and signed papers, you must first create an account.

Fill out your act 114 prescriber consent online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now