Get Triplicate Prescription Program - Cpsaca

The Triplicate Prescription Program - Cpsaca application form is essential for medical residents seeking to participate in the program. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete your application form.

1. Press the ‘Get Form’ button to access the Triplicate Prescription Program application form and open it in your chosen document editor.
2. In the section marked *Name, enter your first name, middle initial(s), and last name as per your official identification.
3. Locate the field labeled Regulatory Authority License or Registration # and fill in your valid license or registration number.
4. In the **Delivery Address section, provide a complete street address where the prescription pads should be sent, ensuring to avoid P.O. Boxes and out-of-province addresses.
5. Complete the **Information to be printed on pad portion with your preferred name as you would like it to appear on the prescription pads.
6. Fill in the Residency Program Name field with the official name of your residency program.
7. Include the **Telephone of Residency Program and list the street address, city, postal code, as well as a contact phone number and fax number.
8. Choose your preferred method of correspondence from the options provided: regular mail, pager number, or email. If selecting email, ensure you enter a **CPSA verified email address.
9. Make sure to sign the form where indicated, and include the date of your signature.
10. Lastly, save your changes, then download, print, or share the completed form as needed.

Start completing your documents online now!