Get State Of California Forms Bne

This guide provides clear and concise instructions on how to complete the State Of California Forms Bne online. Whether you are an experienced prescriber or new to the process, these steps will help ensure your form is filled out accurately and efficiently.

Follow the steps to fill out the State Of California Forms Bne online

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering your prescriber or dispenser name in the designated field.
3. Input your medical license number accurately in the provided space.
4. Fill out the address field with your complete mailing address.
5. Enter your telephone number in the appropriate section.
6. Provide your DEA number in the specified area of the form.
7. Indicate your category of licensure in the corresponding field.
8. For each dispensing event, enter the date of dispensing in the appropriate section.
9. Record the numeric quantity of the drug dispensed for each patient.
10. Input the patient’s first name and last name in their respective fields.
11. Select the gender code for each patient, using 1 for male and 2 for female.
12. Provide the patient’s address, including city, state, and zip code.
13. Enter the ICD code related to the dispensed drug for proper documentation.
14. List the name of the drug dispensed for each entry.
15. Complete fields for the NDC number and Rx number as required.
16. Fill in the strength of the prescription in the designated fields.
17. Input the patient's date of birth accurately.
18. At the end of the form, indicate the reporting month and year.
19. Once all fields are completed, review the information for accuracy.
20. Save your changes, and select options to download, print, or share the completed form.

Complete your forms online today and ensure compliance with the State Of California regulations.