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Ns issued to RPAs by the Department of Health must contain the imprinted names of both the RPA and his or her supervising physician, pursuant to Section 94.2 of Title 10. Please complete and enclose this form with your registration form for the Official Prescription Program. I. To Be Completed by Supervising Physician I hereby authorize (Name of RPA) to order official New York State prescriptions from the New York State Department of Health impr.

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Filling out the Xdibos form online is a straightforward process designed to help users easily navigate through the required fields. This guide will walk you through each section of the form, ensuring that you complete it accurately and efficiently.

Follow the steps to complete your Xdibos form online.

  1. Click ‘Get Form’ button to obtain the form and open it in an online editor. This action will allow you to access the necessary fields for completion.
  2. Begin with Section I, to be completed by the supervising physician. Enter the name of the registered physician assistant (RPA) who is authorized to order official New York State prescriptions. This should be clearly printed.
  3. In the same section, the supervising physician must provide their New York State license number and, if applicable, their DEA registration number.
  4. The supervising physician must sign and date this section, indicating their commitment to inform the Bureau of Narcotic Enforcement if the supervisory relationship changes.
  5. Next, move to Section II, which is to be completed by the RPA. The RPA must print their own name and include their New York State license number.
  6. Further, the RPA needs to provide their DEA registration number in this section.
  7. The RPA must also sign and date this section, noting that they will promptly notify the Bureau of Narcotic Enforcement should their association with the supervising physician discontinue.
  8. Review the entire form for accuracy. Once all necessary fields have been filled out, you can proceed to save changes, download the completed form, and share or print it as needed.

Complete your Xdibos form online today to ensure a smooth and efficient process.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232