Forms and Manuals


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

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
Archive: