NY DOH-166 2010-2025 free printable template
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5 mg Tablet Quantity or Liquid Amount Reason for Disposal/ Destruction Source of Controlled Substance Rx Number Class 3A license holders only Discontinued Smith Pharmacy 1234567 Page of DOH-166 7/10 Page 1 of 1. NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Narcotic Enforcement Name of Person Completing Form CONTROLLED SUBSTANCE INVENTORY FORM Title Office Use Only Signature LOG NUMBER Controlled Substance License Name of Controlled Substance Example Note If the facility/program or individual...
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How to fill out printable controlled substance inventory log form
How to fill out NY DOH-166
01
Obtain the NY DOH-166 form from the New York State Department of Health website or your local health department office.
02
Fill in the applicant's name and address at the top of the form.
03
Provide information regarding the business or organization, including its name and address.
04
Specify the type of facility or service you are operating.
05
Complete the sections that ask for details about your staffing, including qualifications and roles.
06
Provide information on any relevant licenses or certifications held.
07
Ensure you have all necessary documentation required to support your application.
08
Sign and date the form to certify that the information provided is accurate.
09
Submit the completed form according to the instructions provided, either by mail or electronically.
Who needs NY DOH-166?
01
Individuals or organizations operating health-related facilities in New York.
02
Healthcare providers seeking to request credentials or licenses.
03
Establishments applying for permits related to public health activities.
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People Also Ask about controlled substance inventory form
What is a DEA form 222 used for quizlet?
A DEA Form 222 is required for each distribution, purchase, or transfer of a schedule II controlled substance.
What is DEA form 222 used for?
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.
What are the 4 types of controlled substances?
The control applies to the way the substance is made, used, handled, stored, and distributed. Controlled substances include opioids, stimulants, depressants, hallucinogens, and anabolic steroids.
What is a 41 form?
PURPOSE: To document the surrender of controlled substances which have been forwarded by registrants to DEA for disposal. ROUTINE USES: This form is required by Federal Regulations for the surrender of unwanted Controlled Substances.
What is DEA form 363 used for?
These practitioners register as Narcotic Treatment Programs using DEA Form 363, and using DEA Form 363a for renewals. DEA is proposing to revise the regulations for application and renewal by requiring all DEA registrants to apply for registration online using the agency's secure portal.
What drugs must be ordered using a DEA 222?
DEA Forms 222 for carfentanil, etorphine hydrochloride, and diprenorphine must contain only these substances. (c) The name and address of the supplier from whom the controlled substances are being ordered must be entered on the form. Only one supplier may be listed on any form.
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What is NY DOH-166?
NY DOH-166 is a form used by the New York State Department of Health for the reporting of certain health-related information.
Who is required to file NY DOH-166?
Entities such as hospitals, healthcare providers, and other organizations that operate within the healthcare system of New York State are required to file NY DOH-166.
How to fill out NY DOH-166?
To fill out NY DOH-166, you need to accurately provide all required information, complete the necessary sections, and submit it as per the guidelines provided by the NY State Department of Health.
What is the purpose of NY DOH-166?
The purpose of NY DOH-166 is to ensure that health data is collected and reported for monitoring, planning, and improving public health in the state.
What information must be reported on NY DOH-166?
The information that must be reported on NY DOH-166 includes patient demographics, medical condition codes, treatment details, and other relevant health data.
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