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H.P. Akthar Gel Ticket #: ___Request Date: ___Request Time: ___H. P. Akthar Gel Prior Authorization Request Form (Page 1 of 3) DO NOT COPY FOR FUTURE USE. FORMS ARE UPDATED FREQUENTLY AND MAY BE BARCODEDMember

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Form obscure drug is filed with the Drug Enforcement Administration.

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Manufacturers, distributors, importers, and exporters of controlled substances are required to file form obscure drug.

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The purpose of form obscure drug is to monitor the distribution of controlled substances and ensure compliance with regulations.

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Information such as the type and quantity of controlled substances distributed, as well as the recipient of the drugs.

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