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Dea waiver form 2026
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- Click ‘Get Form’ to open the DEA waiver form in the editor.
- Begin by filling in your personal information as a non-prescribing practitioner. Include your name, NPI, and any relevant details that explain why you do not prescribe medications.
- In the designated area, provide a clear statement certifying that you will not prescribe or dispense medications. Ensure you sign and date this section.
- Identify a credentialed Blue Cross Blue Shield of Massachusetts practitioner who will prescribe for your patients. Fill in their name and NPI in the appropriate fields.
- If applicable, indicate if your DEA application is in process by providing the date of application and signing again. Include the name of another credentialed practitioner who will assist during this period.
- Once all sections are completed, review your entries for accuracy before saving or exporting the document for submission via fax or email.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2023 | 4.4 Satisfied (32 Votes) | |
| 2023 | 4.2 Satisfied (49 Votes) | |
| 2022 | 4.8 Satisfied (55 Votes) | |
| 2020 | 4.8 Satisfied (247 Votes) | |
| 2020 | 4.8 Satisfied (101 Votes) | |
| 2020 | 4.4 Satisfied (134 Votes) | |
| 2020 | 4.8 Satisfied (261 Votes) | |
| 2020 | 4.8 Satisfied (117 Votes) | |
| 2020 | 4.3 Satisfied (26 Votes) | |
| 2020 | 4.7 Satisfied (51 Votes) | |
| 2020 | 4.2 Satisfied (36 Votes) | |
| 2020 | 4.1 Satisfied (59 Votes) | |
| 2020 | 4.5 Satisfied (39 Votes) | |
| 2019 | 4.8 Satisfied (130 Votes) | |
| 2019 | 4.8 Satisfied (79 Votes) |
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