Maintenance Treatment Emergency Fax Maintenance Controlled Prescription Form Documentation - bcpharm 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Prescriber' information, including your name and CPSID. This identifies you as the prescribing physician.
3. Fill in the 'Patient Name' field with the name of the patient requiring medication.
4. Input the 'Pharmacy' name and 'Fax Number' where the prescription will be sent.
5. Complete the 'Date' field to indicate when this form is being filled out.
6. In the section requesting a faxed transmission, confirm your understanding that the original prescription must follow by checking the appropriate box or providing a signature.
7. Describe the emergency situation briefly in the designated area to provide context for this urgent request.
8. Finally, sign and date at the bottom of the form to validate your request before sending it back via fax.

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