Thursday, April 1, 2021
Forms related to the Prescription Drug Monitoring Program (PDMP)
File SizeFile SizeFile SizeFile SizeFile SizeFile Size
Dispenser Waiver Form - 1.7 MB (pdf) Delegate Registration Form - 679.3 KB (pdf) Law Enforcement Registration Form - 707.8 KB (pdf) Law Enforcement Records Request Form - 1.1 MB (pdf) Patient Self Records Request Form - 222.2 KB (pdf) Patient Representative Records Request Form - 232.3 KB (pdf)
Attachment(s):
Dispenser Waiver Form - 1.7 MB (pdf) Delegate Registration Form - 679.3 KB (pdf) Law Enforcement Registration Form - 707.8 KB (pdf) Law Enforcement Records Request Form - 1.1 MB (pdf) Patient Self Records Request Form - 222.2 KB (pdf) Patient Representative Records Request Form - 232.3 KB (pdf)