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Avoid having your form returned! Were here to help!!! Call our DEA Compliance Team 1.888.222.3722, prompt 5. DEA 222 Form Sample (New Single Page) PURCHASER INFORMATIONOnce completed, make a copy

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How to fill out dea 222 form sample

01

Begin by entering the name and address of the supplier on the top portion of the form.

02

Next, fill in the date on which the order is being placed.

03

In the table section, provide the name, strength, and size of the controlled substance being ordered.

04

Enter the number of containers or packages being ordered.

05

Indicate the number of units in each container or package.

06

Calculate the total quantity of the ordered substance.

07

Fill in the name and address of the purchaser in the respective fields.

08

If any changes need to be made to the order, mark the appropriate box and provide explanations.

09

Sign and date the form before submitting it to the supplier.

10

Retain a copy of the completed form for your records.

Who needs dea 222 form sample?

01

The DEA 222 form sample is required by anyone who is registered with the Drug Enforcement Administration (DEA) and is involved in the ordering and distributing of controlled substances.

02

This includes manufacturers, distributors, pharmacies, and other entities authorized to handle controlled substances.

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What is DEA 222 form sample?

The DEA 222 form is an official document used in the United States to order Schedule I and II controlled substances. It serves as a means for registered practitioners and pharmacies to request these substances from licensed suppliers.

Who is required to file DEA 222 form sample?

Licensed practitioners, such as physicians, dentists, and veterinarians, who are registered to handle controlled substances, as well as pharmacies, must file the DEA 222 form when ordering Schedule I and II drugs.

How to fill out DEA 222 form sample?

To fill out the DEA 222 form, the requester must enter their DEA registration number, the name and address of the supplier, and the specific controlled substances being ordered, including the quantity and dosage form. The form must be signed and dated by the authorized individual.

What is the purpose of DEA 222 form sample?

The purpose of the DEA 222 form is to provide a controlled and accountable way to order and track Schedule I and II controlled substances, helping to prevent misuse and diversion of these powerful drugs.

What information must be reported on DEA 222 form sample?

The DEA 222 form must include the purchaser's DEA registration number, the name and address of the purchaser, the name and address of the supplier, the date of the order, and a list of the controlled substances being ordered, including their corresponding quantities.

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