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University of Michigan Use of Controlled Substances in Research Sample DEA Form 222 No order form may be issued for Schedule I and II substances unless a See Reverse of PURCHASERS OMB APPROVAL completed

How to fill out dea 222 form

How to fill out DEA Form 222:

1. Obtain the required form from the Drug Enforcement Administration (DEA) or an authorized distributor. The form can be downloaded from the DEA's website or requested through mail.
2. Fill out the top portion of the form with the name and address of the supplier from whom controlled substances are being ordered. Include the supplier's DEA registration number and the date of the order.
3. Next, provide the name, address, and DEA registration number of the pharmacy or practitioner placing the order in the middle section of the form.
4. In the bottom section, list the specific controlled substances being ordered. Include the name, strength, dosage form, and the number of packages or items being requested.
5. Sign and date the form in the designated areas to certify the accuracy of the information provided.
6. Retain a copy of the completed DEA Form 222 for record-keeping purposes.

Who needs DEA Form 222?

1. DEA Form 222 is required for any pharmacy or practitioner who intends to order or transfer Schedule I or II controlled substances.
2. It is commonly used by pharmacies, hospitals, and other medical institutions to order narcotics and other controlled substances from drug manufacturers or wholesalers.
3. DEA Form 222 ensures that the procurement and distribution of controlled substances comply with federal regulations and helps to prevent their misuse or diversion.

People Also Ask about sample dea form 222

How do you order a single 222 sheet?

To order the single sheet forms, providers are instructed to visit the form request page. They will need the information from their registration certificate in order to login.

What is a DEA controlled substance?

Controlled substances are drugs or chemicals that have the potential to be addictive or habit-forming. The United States Drug Enforcement Agency (DEA) divides controlled substances into 5 categories called Schedules based upon substances' potential for abuse and addictiveness and its' usefulness in medicine.

Are DEA 222 forms still used?

As of October 30, 2021, the Drug Enforcement Administration mandated the use of single sheet DEA 222 Forms for those providers who prescribe schedule 2 controlled substances (meperidine/Demerol, and fentanyl). At this time, triplicate DEA 222 forms are no longer be available or utilized, ing to federal law.

What is a DEA 222 form used?

The Drug Enforcement Administration (DEA), Office of Diversion Control, will accept requests from distributors that require a large volume of Order Forms (DEA Form 222) with the pin feed tracking left on the form. Order Forms are used for the distribution of a Schedule I or II controlled substance.

What is a DEA 222 form when is it required and how is it executed?

DEA Form 222 is similar to a prescription pad or order form that allows DEA registrants to order and transfer Schedule I and Schedule II controlled substances. The registrant is responsible for obtaining the form and retaining the executed and unexecuted forms to comply with record-keeping requirements.

What must be recorded on DEA Form 222?

(e) The purchaser must record on its copy of the DEA Form 222 the number of commercial or bulk containers furnished on each item and the dates on which the containers are received by the purchaser.

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What is dea 222 form example?

The DEA 222 form is a triplicate order form used for the purchase and transfer of Schedule I and II controlled substances. It is necessary for documenting the receipt of these substances.

Who is required to file dea 222 form example?

Pharmacies, hospitals, and practitioners who wish to order Schedule I or II controlled substances must file a DEA 222 form. Additionally, manufacturers and distributors of these substances also need to use this form for transfers.

How to fill out dea 222 form example?

To fill out the DEA 222 form, specify the name and address of the purchaser, the registration number, and a complete list of the controlled substances being ordered, along with their quantities. The form requires three copies, one for the purchaser, one for the supplier, and one for the DEA.

What is the purpose of dea 222 form example?

The purpose of the DEA 222 form is to ensure that the distribution of controlled substances is tracked and regulated, thus preventing misuse and illegal trafficking. It acts as a safeguard in the procurement process.

What information must be reported on dea 222 form example?

The DEA 222 form must include the purchaser's name, address, and DEA registration number, along with a detailed list of controlled substances ordered, including their names, dosage forms, and quantities.