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BI232 9/2014 Return completed form to: Controlled Substance Report Backstreet Insurance P.O. Box 3151 Charleston, WV 253323151 1. Diagnosis code(s) responsible for the claimants pain: Date: Claimant

How to fill out controlled substance report

How to fill out controlled substance report:

1. Begin by gathering all relevant information about the controlled substance. This includes the name of the substance, dosage, quantity, and any other pertinent details.
2. Next, identify the patient or individual for whom the controlled substance is being administered. Record their full name, date of birth, and any other identification information required.
3. Document the date and time when the controlled substance was administered or distributed.
4. Indicate the reason for administering the controlled substance. This could include pain management, treatment of a specific condition, or any other therapeutic purpose.
5. Describe the method of administration, whether it was through oral ingestion, injection, or any other route.
6. Specify the dosage and quantity administered. Include both the prescribed amount and the actual amount given.
7. If applicable, note any side effects or adverse reactions observed after administering the controlled substance.
8. Finally, sign and date the report, ensuring that it is legible and easily identifiable.

Who needs a controlled substance report:

1. Healthcare professionals: Doctors, nurses, and other medical professionals who prescribe or administer controlled substances are required to maintain accurate and up-to-date reports.
2. Pharmacists: Those responsible for dispensing controlled substances are also responsible for keeping a record of each transaction and ensuring it complies with relevant regulations.
3. Law enforcement agencies: Controlled substance reports serve as crucial documentation for law enforcement agencies investigating the illegal distribution or misuse of controlled substances.
4. Regulatory agencies: Government bodies tasked with overseeing the use and distribution of controlled substances often require reports to monitor and enforce compliance with regulations.
5. Insurance companies: In some cases, insurance providers may request controlled substance reports to verify the appropriate use and administration of medications.

Note: The specific individuals or entities who need a controlled substance report may vary depending on local regulations and organizational policies. It is essential to consult and adhere to the guidelines set forth by relevant authorities.

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What is controlled substance report?

Controlled substance report is a document used to track the use and distribution of controlled substances in a healthcare setting.

Who is required to file controlled substance report?

Healthcare facilities and practitioners who handle controlled substances are required to file controlled substance reports.

How to fill out controlled substance report?

Controlled substance reports are typically filled out electronically or on paper forms provided by the relevant regulatory agency.

What is the purpose of controlled substance report?

The purpose of controlled substance report is to prevent diversion and misuse of controlled substances, as well as to ensure compliance with regulations.

What information must be reported on controlled substance report?

Controlled substance reports must include information on the type and quantity of controlled substances received, dispensed, and disposed of, as well as patient information and prescribing practitioner.