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BI233 9/2014 Controlled Substance Followup Report Return completed form to: Backstreet Insurance P.O. Box 3151 Charleston, West Virginia 253323151 Claimant Name: Date: Claim Number: Vendor Number:

How to fill out controlled substance follow-up report

How to fill out controlled substance follow-up report:

1. Gather relevant information: Before filling out the controlled substance follow-up report, gather all the necessary information such as the patient's name, date of birth, medical record number, and the specific controlled substance involved.
2. Identify the reason for the follow-up report: Understand why the report is being filled out. Typically, controlled substance follow-up reports are required when there are discrepancies, errors, or concerns related to the prescribing, dispensing, or administration of controlled substances.
3. Fill out the patient information: Start by providing the patient's identifying information accurately. Include their full name, date of birth, address, contact information, and any other relevant details.
4. Document the details of the controlled substance: Clearly list the details of the controlled substance being reported, including the name, strength, quantity, dosage form, and specific brand (if applicable). Provide details of the prescription, such as the prescribing physician's name, DEA number, and the date the prescription was issued.
5. State the reason for the follow-up report: Clearly explain the reason for filling out the controlled substance follow-up report. This may include issues like suspected diversion, theft, loss, tampering, or discrepancies in administration records.
6. Provide a detailed description: Use clear and concise language to describe the incident or concern in detail. Include any relevant dates, times, locations, and individuals involved. Be objective and factual while describing the events.
7. Attach supporting documentation: Whenever possible, attach any supporting documentation that can substantiate the concerns raised in the report. This may include copies of prescription forms, dispensing records, medication administration records, witness statements, or any other relevant evidence.
8. Review and double-check: Before submitting the report, carefully review all the information entered for accuracy and completeness. Ensure that all the required fields are filled out properly and that there are no typographical errors.

Who needs controlled substance follow-up report:

1. Healthcare Professionals: Physicians, nurses, pharmacists, and other healthcare professionals who encounter discrepancies, errors, or concerns related to controlled substances may need to fill out a controlled substance follow-up report.
2. Regulating authorities: Regulatory bodies, such as state or federal agencies responsible for monitoring controlled substances, may require healthcare professionals to submit a follow-up report when certain incidents occur.
3. Law enforcement agencies: In cases where controlled substances are involved in suspicious activities, theft, diversion, or other illicit practices, law enforcement agencies may request or require a controlled substance follow-up report.

Note: The specific requirements for filling out this report may vary depending on regional regulations and policies. It is essential to follow the guidelines provided by the applicable governing authority or organization.

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What is controlled substance follow-up report?

Controlled substance follow-up report is a document that provides information about the status and usage of controlled substances within a specific timeframe.

Who is required to file controlled substance follow-up report?

Certain healthcare providers and entities are required to file controlled substance follow-up reports as mandated by state regulations.

How to fill out controlled substance follow-up report?

Controlled substance follow-up reports can typically be filled out electronically or by using a specific form provided by the regulating agency.

What is the purpose of controlled substance follow-up report?

The purpose of the controlled substance follow-up report is to monitor and track the distribution and usage of controlled substances to ensure regulatory compliance and prevent misuse.

What information must be reported on controlled substance follow-up report?

Information such as the quantity of controlled substances used or sold, the names of individuals prescribing or dispensing the substances, and details of any discrepancies or discrepancies must be reported on the controlled substance follow-up report.