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28150 Avenue Crocker, Suite 220 Valencia, CA 9135546506612576000 8006400992 6612573431 Former Blank for California Standard Format Secure Prescription Forms Please complete this form and fax back
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How to fill out new controlled prescription program

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Step 1: Obtain a copy of the new controlled prescription program form.
02
Step 2: Fill in your personal information, including your name, address, and date of birth.
03
Step 3: Provide information about your healthcare provider, including their name, address, and phone number.
04
Step 4: Indicate the controlled substance you are being prescribed and the dosage.
05
Step 5: If applicable, provide information about any previous controlled substances you have been prescribed.
06
Step 6: Sign and date the form.
07
Step 7: Submit the completed form to the appropriate authority or healthcare facility.

Who needs new controlled prescription program?

01
The new controlled prescription program is needed by healthcare providers, pharmacies, and patients who are involved in the prescribing, dispensing, and consumption of controlled substances.
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The new controlled prescription program is a regulatory framework aimed at monitoring and managing the prescription of controlled substances to prevent misuse and ensure that patients receive necessary medications safely.
Healthcare providers who prescribe controlled substances, including physicians, dentists, and other authorized practitioners, are required to file under the new controlled prescription program.
To fill out the new controlled prescription program, practitioners must complete a designated form that includes patient information, medication details, and the provider's information, ensuring all data is accurate and complete.
The purpose of the new controlled prescription program is to enhance patient safety by tracking prescriptions for controlled substances, reducing the potential for abuse, and improving drug monitoring.
The information that must be reported includes patient identification, the prescribed controlled substance, the quantity dispensed, dates of issuance and filling, and prescriber details.
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