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The document is a Controlled Substance Inventory Form from the New York State Department of Health's Bureau of Narcotic Enforcement. It is used to record details about controlled substances, including the name, strength, quantity, reason for disposal, and source of the substance. The form is intended for use by licensed facilities or individuals managing controlled substances.

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Click ‘Get Form’ to open the controlled substance inventory form in the editor.
Begin by entering your name in the 'Name of Person Completing Form' field. This identifies who is responsible for the information provided.
Fill in your title in the designated section to clarify your position within the organization.
In the 'Controlled Substance License #' field, input your license number if applicable, ensuring compliance with regulations.
Specify the 'Name of Controlled Substance' you are documenting, such as Lorazepam, to accurately reflect what is being reported.
Indicate the 'Strength/Dosage Form' of the substance, for example, 0.5 mg Tablet, to provide precise details about its formulation.
Enter the 'Quantity or Liquid Amount' that corresponds to what you are reporting or disposing of.
State the 'Reason for Disposal/Destruction', such as discontinued use, which helps justify your actions regarding this substance.
Identify the 'Source of Controlled Substance', like Smith Pharmacy, to trace where it was obtained.
If applicable, include an Rx Number in the designated area for Class 3A license holders only.

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2010	4.8 Satisfied (289 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a Form 41 controlled substance?

DEA Form 41 is used to request permission from the DEA to destroy controlled substances. The only time University researchers use Form 41 is after controlled substances have been lost due to accidentally spilling or breaking a container.

What is an example of a controlled substance?

Some examples are morphine, , oxycodone (OxyContin), , methylphenidate (Ritalin), and (). Schedule III, IV, or V drugs with an abuse risk less than Schedule II. These drugs also have safe and accepted medical uses in the United States.

What is a 222 form for drugs?

The Drug Enforcement Administration (DEA), Office of Diversion Control, will accept requests from distributors that require a large volume of Order Forms (DEA Form 222) with the pin feed tracking left on the form. Order Forms are used for the distribution of a Schedule I or II controlled substance.

Who fills out the 222 form?

The DEA Form 222 can be executed with the use of a typewriter, computer printer, pen or indelible pencil according to the DEA. Only the DEA registrant and a person to whom the registrant has granted signing authority via a properly executive Power of Attorney form may sign the 222 form.

What is the most important consideration when executing a DEA form 222?

Question: What is the MOST important consideration when executing a DEA Form 222? The supplier gets a copy of the DEA form for their records. Any errors made on the order form should be erased completely. Enter only one item on each numbered line.

controlled substance inventory form

Controlled substance form template Printable controlled substance form Controlled substance form pdf DEA Form 41 DEA Form 106 DEA Form 222 Controlled substance form online Controlled substance form texas

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What is a controlled substance certificate?

A Controlled Dangerous Substance (CDS) license is a legal permit issued by state authorities that allows individuals or entities to handle, store, distribute, or dispense controlled substances for medical or scientific purposes.

What is a DEA Form 222 used for?

Using DEA Form 222 to transfer Schedule II Drugs To transfer a C-II controlled substance, like sodium pentobarbital, between laboratories, a DEA Form 222 order form is required. The receiving party must have a DEA Form 222. One laboratory is the supplier, acting like a pharmacy.

How often should DEA form 222 be submitted?

Under 21 CFR 1305.03, the completion of DEA Form 222 is required for each distribution of a schedule I or II controlled substance.

Controlled substance form 2026

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What is a Form 41 controlled substance?

What is an example of a controlled substance?

What is a 222 form for drugs?

Who fills out the 222 form?

What is the most important consideration when executing a DEA form 222?

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What is a controlled substance certificate?

What is a DEA Form 222 used for?

How often should DEA form 222 be submitted?

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