Get Sma 162

The Sma 162 form is essential for individuals or organizations seeking certification to use opioid drugs in a treatment program. Following this guide will help you navigate the process of completing the form online with ease and accuracy.

Follow the steps to successfully complete the Sma 162 form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in the sponsor information. This includes providing the name of the program sponsor, who is responsible for ensuring compliance with federal opioid treatment standards.
3. Describe the current accreditation status of your Opioid Treatment Program (OTP). Include the name and address of the accreditation body, the date of the last accreditation, and a copy of the application submitted to the accreditation body.
4. Outline the organizational structure of the program. This should include a chart that displays the position and title of key personnel along with the name and address of the central administration.
5. List all facilities utilized by the OTP for medical and rehabilitative services, providing complete names and addresses.
6. Designate a medical director responsible for administering all medical services. If the medical director is also affiliated with another program, include a justification for this arrangement along with a copy of their state license and curriculum vitae.
7. Include information on any secondary dispensing locations where medications such as or LAAM will be provided.
8. List individuals licensed to dispense narcotic drugs, including their names and state license numbers.
9. Provide a tentative schedule outlining dispensing hours, counseling hours, and staffing hours for all personnel.
10. Detail funding sources including the name and address of any governmental agencies providing financial support.
11. Describe the facilities to be used for the program, ensuring they are suitable for drug dispensing and counseling services.
12. Affirm the number of patients expected when the program operates at full capacity and include a statement about safety closures for take-home medications.
13. Finalize by saving your changes. You can choose to download a copy, print, or share the completed form.

Complete the Sma 162 form online today to ensure compliance with opioid treatment standards.