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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.
Created by: Xander635
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