click below
click below
Normal Size Small Size show me how
DEA forms
| DEA form # | Definition |
|---|---|
| DEA 224 | for DISPENSERS including retail pharmacies, hospitals/clinics, practitioners, mid-level practitioners, and teaching institutions. Renewal is 224a *this is for DEA registration |
| DEA 225 | For manufacturers, distributors, researchers, analytical laboratories, importers, and exporters. Renewal is 225a **this is for DEA registration |
| DEA 363 | For narcotic treatment facilities. Renewal is 363a **this is for DEA registration |
| DEA 222 | required for each sale or transfer of Schedule II drugs (except dispensing to ultimate user); also used for each sale and transfer of Schedule I controlled substances if authorized for use in research or clinical trials; * only a single item may be ordered on each numbered line (contains 20 order lines per form) |
| DEA 106 | Theft or Loss of Controlled Substances; must be reported in writing to DEA within 1 business day of discovery of the theft or significant loss and DEA recommends notifying local police *TSBP also requires notification to the Board of a theft or sig. loss immediately upon discovery *must be input to DEA's TLR within 45 days *any theft must be reported but only "significant" loss ⭐️ *initial notification made in writing within 1 business day but actual DEA 106--> 45 days after discovery |
| DEA 106 requires | Name and address of the registrant DEA registration # Date of theft Name and telephone # of local police department notified Type of theft (break-in employee) Total value (amount paid) for the CS lost or stolen Listing of CS missing from theft or sig. loss NDC # of the missing products Listing of mail-back packages or inner liners lost or stolen |
| DEA 107 | Reporting Losses of Listed Chemicals (Primarily Pseudoephedrine products in a pharmacy) *requires any unusual or excessive loss or disappearance of a listed chemical reported to DEA at the earliest practicable opportunity. *complete and accurate report filed within 15 calendar days after becoming aware |
| DEA 41 | On-site destruction of CS in a pharmacy (authorized collector) which requires the name and NDC # of the drug, strength, dosage form, package size, and the quantitiy of the CS destroyed; requires 2 signatures of empployees who witnessed |
| For a transfer to an authorized (Registered) reverse distributor is a transfer from one DEA registrant (pharmacy) to another (reverse distributor). Transfer myst be documented with an invoice for Schedules ___-___ and a DEA 222 for Schedule ___. | III-V; II; *Bc this is a transfer from one DEA registrant (pharmacy) to another (reverse distributor), a DEA Form 41 is not required |
| Sealed liner stolen, lost, or missing from an Authorized collector's registered location (or authorized LTCF) before the sealed inner liner is picked up for destruction or destroyed on-site, the Authorized collector must report the theft or loss and file a DEA form ____ for sealed inner liner | 106 |
| Wasting of a partial quantity of a controlled substance does not require use of a DEA form ___ | 41 *already been accounted for since it was ordered for and administered to a patient |
| The witnessed breakage or spillage of a CS does not constitute a loss of a CS bc the registrant can account for the CS. These types of incidents do not require notification to DEA using DEA form ___ | 106 |
| It is DEA's position that in order to maintain complete and accurate records, any non-recoverable breakage or spillage must be recored on a DEA form ___, including being signed by 2 individuals who can testify that a breakage or spillage occurred | 41 |
| An applicant can authorize another individual to sign the DEA application and renewals by filling out a ____ __ _____ (POA) granting that individual the authority and filling that POA with the DEA Registration Unit | Power of Attorney *does not need to be sent to DEA but must be maintained in the pharmacy |
| Registration renewal notifications not by mail but electronically reminded to renew is sent at __, ___. ___, ___, and 5 days prior to the expiration date of the registration to the associated email address | 60, 45, 30, 15 |
| DEA allows reinstatement of an expired registration for __ calendar month after the expiration date. If not renewed within that calendar month, an application for a new DEA registration will be required | 1 |
| Exemptions (who does not have to register with DEA) includes an agent or employee of any registered manufacturer, distributor, or dispenser if acting in the ____ ____ of business or employment; same for common/contract carrier/ultimate user/ US Armed Services, Public Health Services, or Bureau of Prisons | usual course *also includes pharmacist working in a pharmacy and nurses working in a hospital or physician's office |
| Federal practitioners (US armed services, Public Health Service, Bureau of Prisons) can issue E-script C-II. However, can't issue ____ C-II prescriptions to be filled __ __ or out of the facility where they practice. This is bc they would not be written on a ____ _____ ___ ___ | off-base; Texas Official Prescription Form; *when an exemption for E-script applies for Schedule III-V CS, written rx can be filled off-base |
| DEA 222: Orders for _____, ______ ____, and _______ must only contain orders for those sunstances. These are super-potent marcotics primarily used as animal tranquilizers | carfentanil, etorphine hydrochloride, diprenorphine |
| While a POA to order CS is not required to be sent to DEA when using a MANUAL DEA Form 222, it is required to be sent to DEA in order to obtain a ____ signing certificate | CSOS (Controlled Substance Ordering System) |
| Manufacturers, distributors, reverse distributors, and narcotic treatment programs can also modify their DEA registration to serve as an _____ _____. | Authorized Collector |
| Perpetual inventory is only required in TEXAS for: Schedule II CS in Class __ (institutional) pharmacies; all CS at a ___ _____ under the remote pharmacy rules; all CS at a Class C (ASC), all CS at Class _ (freestanding emergency medical care facility) | C; remote location; F |
| TSBP rules require the ____ of the receiving pharmacist on invoices for CS, except in Class __-____ and Class __ pharmacies since there may not be a pharmacist present and person receiving is required to sign for ______ | initials; C-ASC; F; receipt |
| Corresponding responsibility Doctrine was implemented bc: | a pharmacist cannot simply rely on the fact that a physician has a VALID DEA registration to determine if a CS prescription is valid |
| C-II: TSBP indicated that pharmacists may follow the federal law for faxed scripts. The faxed rx would need to contain the ___ ____ ___ ___ and situations such as: | Texas Official Prescription Form - Schedule -II to be compounded for direct admin to a pt by parenteral, IV, IM, SQ, or intraspinal; - pt is a resident of a LTCF; - pt is on hospice care and must be noted. |