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Issue and Record Emergency Medication You Dispense

Instructionsadd

In order to search the Central Registry database for the patient requesting emergency dosing, you must have a written consent signed by the patient. Please use the sample consent form if you do not have one available before you continue to dose.

Do you have a signed consent/release of information form from this patient?

If this patient consents to access their medication records please select yes and enter the patient's home state and identifying information to check our records.
Yes Print Consent Form