Forms and Manuals


Please Note:
All forms are in Portable Document Format (PDF). You will need Adobe Acrobat Reader in order to view and print.

Prescriber:
Dispenser:

*The 'Dispenser Waiver Request Form' is only to be used to request a waiver for specific PMP requirements concerning dispensation uploads. The 'Dispenser Waiver Request Form' does not pertain to e-Prescribing Exemption Requests for controlled substances. Any prescriber seeking an exemption from e-prescribing of controlled substances can find instructions for making the request at: https://portal.ct.gov/DCP/Drug-Control-Division/Drug-Control/EPCS-Information-Page

 

 CPMRS Registration Notary Forms:

Healthcare Professional  Law Enforcement Other
Physician (MD, DO) DEA Medical Marijuana Registry 
Medical Resident with Prescriptive Authority Local  
Dentist Medicaid Fraud Units  
Veterinarian Multijurisdictional Task Force   
Podiatrist (DPM) OIG  
Prescriber without DEA State Police  
VA Prescriber VA Investigator  
Military Prescriber State Drug Control Agent  
Optometrist    
Physician Assistant    
Nurse Practitioner/Clinical Nurse Specialist    
Midwife with Prescriptive Authority    
Prescriber Delegate - Unlicensed    
Prescriber Delegate - Licensed    
Pharmacist    
Pharmacist's Delegate - Licensed    
VA Dispenser    

 

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