DEA Forms Flashcards
Form used to document disposal and destruction of scheduled drugs
Form 41
New application for Domestic chemical *precursor drugs used in the manufacture of controls)
Form 510
Used to report excessive loss or theft
Form 106
Form for ordering/receiving C1 and C2 meds
Form 222
New application for Narcotic treatment programs
Form 363
NEW application for Pharmacies, practitioners, and mid-level practitioners
DEA 224
Renewal of application for Pharmacies, practitioners, and mid-level practitioners
DEA 224a
NEW application for manufacturer, distributor, Researcher, importer, exporter of controls
DEA 225
What color is each copy 1 of DEA 222 form and who keeps it?
Brown
The “supplier” of the C2 drug:
usually the wholesaler, but could be the pharmacy if sending C2s to reverse distributor
What color is each copy 2 of DEA 222 form and who keeps it?
Green
ALWAYS gets forwarded to the DEA
What color is each copy 3 of DEA 222 form and who keeps it?
Blue
The “receiver” of CII’s keeps this copy; generally, the pharmacy that initiates the order of CIIs from a wholesaler
Form used to order DEA 222 forms
DEA form 222a
Notice of inspection of controlled premises
DEA 82
How many lines does a DEA 222 form have? (how many drugs can be ordered from 1 form)
10
DEA 224b form
renew chain pharmacy registration
includes all pharmacies registered
