Get Controlled Substance Authorized Users List (remcs Form 5 - Purdue

Filling out the Controlled Substance Authorized Users List (REMCS Form 5) is crucial for maintaining compliance with regulatory requirements. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and effectively.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the registrant name in the designated field. This should be the name of the DEA license holder.
3. Input the registration number(s) associated with the DEA license in the respective section.
4. Fill in the location name where controlled substances will be accessed. Ensure this matches the registered address.
5. Provide the full location address, including street, city, state, and zip code.
6. List each authorized user by name. For every person you designate, you will need to enter their legal name, signature, and date of birth. Ensure this is printed or typed clearly.
7. For each authorized user, the initials field must reflect how the user’s name appears on administered or dispensed records.
8. After entering all authorized users, you will certify your designation by signing the registrant signature section and entering the date.
9. Once the form is completed, save your changes, then download, print, or share the form as needed. Ensure you send a copy to the Biosafety Officer or to REM/CIVL.
10. Keep a copy of the completed form for your records. It’s essential to update any changes in listed personnel promptly.

Complete your Controlled Substance Authorized Users List online to ensure compliance and keep your records up to date.