Get Notification Of Loss/theft Of Official New York State Prescriptions - Doh-4387. Notification Of

This guide provides clear instructions for filling out the Notification Of Loss/Theft Of Official New York State Prescriptions - DOH-4387. It aims to support users in accurately completing the form to report a lost or stolen prescription.

Follow the steps to accurately complete the form online.

1. Click the ‘Get Form’ button to obtain the document and open it for editing.
2. Enter your name in the designated field at the top of the form. This ensures that the report is correctly attributed to you.
3. Provide your license number in the appropriate section. This information helps verify your professional credentials.
4. Fill in your current address clearly. This will be used for any necessary communication regarding your report.
5. Input your DEA number in the field provided, which is necessary for identifying your professional authorization.
6. Enter your telephone number, enabling the Bureau of Narcotic Enforcement to contact you if needed.
7. List the serial numbers of the missing prescriptions in the specified area. This is critical for tracking and resolving the issue.
8. Indicate the status of the missing prescriptions by checking the appropriate box: Lost, Stolen, or Missing.
9. Provide the name and address of the police authority where you reported the loss. This helps validate your report.
10. Describe the circumstances surrounding the loss in the space allocated. Be as detailed and factual as possible.
11. Document the date of loss in the relevant field to establish a timeline for the incident.
12. Outline the security measures taken to prevent future losses. This may include changes implemented in your practices.
13. Sign and date the form at the bottom, confirming the accuracy of the information provided.
14. Finally, save your changes and then download or print the completed form for your records. Mail the original to the address provided on the form.

Act now to complete and submit your Notification Of Loss/Theft of official New York State prescriptions online.