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NAME OF PROVIDER DR SUPPLIER STREET ADDRESS. CITY, Mrs, ZIP CODE
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AND WEIGHT (lbs). If you have any questions concerning any of the forms or are not sure if this particular drug is available in your area, contact the DEA at 1-800-DOSE-DEAL (). To obtain a free copy of the “Possession of Marijuana for Medical Purposes” form, go to: [FONT=Verdana, Times New Roman] DELISTED DRUGS There is a wide range of drugs available for sale in the state of Minnesota. The sale of Schedule I, V, VI and D drugs requires a prescription from a physician. This form can only be completed by the qualified applicant whose name is listed on the form. To verify the identity of the applicant, a photograph must be submitted along with the required identification card number. The information submitted will be used to verify the patient's identity and provide a prescription for the prescribed drug. The prescription will be issued to the patient's name and will be valid until he is medically released from state care. Citation: M.S.S.A. § 523F.3 DEA Form: DELISTED DRUGS (Marijuana, Narcotics, etc.) A. What is a Class A substance? A Class A substance is any of the following: 1. A substance containing any quantity of cocaine or any of the salts of such substances; 2. A substance containing, whether directly or indirectly, any quantity of heroin or any salt of such substance; 3. A substance containing any quantity of the substances listed in subsection 2; 4. A substance containing any quantity of any other controlled substance specified in subsection 3: (a) Except as provided under paragraph (g), any substance specified under subsection 3(a)(3) while the substance is being manufactured, packed, labeled, stored or made available; (b) At any time upon the making of a controlled substance analog or any controlled substance that is designated as a drug analog under NAC 46.

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