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CONTROLLED DANGEROUS SUBSTANCE DESTRUCTION REPORT

CONTROLLED DANGEROUS SUBSTANCE DESTRUCTION REPORT 2026

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The document is a Controlled Dangerous Substance Destruction Report for Greyswood facility, detailing the destruction of controlled substances. It includes sections for facility information, drug details, destruction method, and signatures of those involved in the process. The report must be submitted to the Division of Drug Control within 10 days and retained for two years.

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Click ‘Get Form’ to open the CONTROLLED DANGEROUS SUBSTANCE DESTRUCTION REPORT in the editor.
Begin by entering the Facility Name and Director of Nursing in the designated fields. Ensure accuracy as this information is crucial for record-keeping.
Fill in the Address, City, and Zip Code. This helps identify the location of the facility responsible for the destruction.
Input the License Number, which is essential for compliance with regulatory standards.
In the Item section, list each drug being destroyed along with its Dosage, Quantity, Form, Strength, Prescription Pharmacy No., and Resident ID. This detailed information is vital for tracking purposes.
Record the Date Destroyed and Method of Destruction. These fields are important for legal documentation.
Complete the Destroyed by and Witnessed by sections with printed names to ensure accountability.
Once all fields are filled out accurately, save your document. Remember to keep a copy for your facility’s records as required.

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2011	3.9 Satisfied (28 Votes)

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What is considered a dangerous controlled substance?

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: , lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and .

How to get a CDS certificate?

How to obtain a CDS license? Step 1: Determine the requirements in their state. Step 2: Complete the necessary education and training. Step 3: Obtain the necessary documentation. Step 4: Apply for the license. Step 5: Maintain compliance with state and federal laws.

Which form must be filled out before destroying a controlled substance?

Registrant Record of Controlled Substances Destroyed - DEA Form 41.

How do I report a controlled substance loss to the DEA?

The DEA Form 106 can be completed via Theft/Loss Reporting Online (TLR). In order to better track controlled substances and listed chemical products reported as lost or stolen, DEA uses of the National Drug Code (NDC) number. The NDC number identifies the manufacturer, product, dosage form, and package size.

What is a 222 form used for?

DEA Form 222s are only used to transfer or order Schedule II controlled substances. Orders for Schedule II agents will not be accepted without a Form 222. Each book of DEA Official Order Forms consists of seven sets of forms.

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