Get the free Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances - dsps wi
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This document is used by pharmacists to provide additional information regarding the theft or loss of controlled substances, including details about police reports, employee pilferage, and security
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How to fill out supplemental dea form for
How to fill out Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances
01
Obtain the Supplemental DEA Form 106 from the DEA website or your local DEA office.
02
Fill out the top section with your registrant information, including name, address, and DEA registration number.
03
Provide details of the theft or loss, including the date of the incident, location, and circumstances surrounding the event.
04
List the controlled substances that were lost or stolen, including the name, dosage form, strength, and quantity.
05
Indicate whether local law enforcement was notified and provide the report number if applicable.
06
Sign and date the form to certify the accuracy of the information provided.
07
Send the completed form to the nearest DEA office and keep a copy for your records.
Who needs Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances?
01
Pharmacies and healthcare providers who have experienced theft or loss of controlled substances.
02
Organizations holding DEA registrations for controlled substances.
03
Anyone handling or managing controlled substances as part of their professional duties.
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What is Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances?
The Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances is a specific form required by the Drug Enforcement Administration (DEA) to report any theft or loss of controlled substances from a registered entity.
Who is required to file Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances?
All licensed pharmacies, practitioners, and other entities that handle controlled substances and experience a theft or loss must file the Supplemental DEA Form.
How to fill out Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances?
To fill out the form, provide information on the registrant's details, a description of the controlled substances lost or stolen, the circumstances of the theft or loss, and any police report numbers if applicable.
What is the purpose of Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances?
The purpose of the Supplemental DEA Form is to ensure compliance with federal regulations surrounding controlled substances and to provide the DEA with necessary information to investigate and address the theft or loss.
What information must be reported on Supplemental DEA Form for Reporting Theft or Loss of Controlled Substances?
The form must include the registrant's name and address, the date of the incident, details of the controlled substances involved, the circumstances surrounding the theft or loss, and any relevant police report numbers.
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