Get Obndd

This guide provides users with clear and detailed instructions on how to effectively fill out the Practitioner Application for OBNDD Registration online. Follow these steps to ensure a smooth application process.

Follow the steps to complete your Obndd application online.

1. Click the ‘Get Form’ button to obtain the application form and open it in the designated editor.
2. Fill in your personal information, including your practitioner name and gender. Select 'M' for male or 'F' for female.
3. Enter your organization name and physical business address. Ensure that you provide a complete street address along with your city and zip code.
4. Indicate whether the application is for a certified and licensed ambulance service or emergency medical response agency by selecting 'Yes' or 'No'. If yes, attach the necessary details regarding your procedures for storage and security of controlled substances.
5. Select your application type: 'New Applicant', 'Renewing Applicant' (and include your OBNDD number), or 'Current Registrant applying for registration at an additional office location'.
6. Provide your email address, cell phone number, business phone number, business fax number, social security number, and date of birth.
7. Specify your profession by choosing from the defined list, and enter your current Oklahoma professional license number along with its issue and expiration dates.
8. List the professional schools you attended and the year you graduated.
9. Provide your NPI number or indicate if it is pending. Also, include your current DEA number and its expiration date.
10. Indicate the schedules you are requesting and whether you seek an exemption from the registration fee. If you do seek an exemption, attach the required verification letter.
11. Answer the questions regarding any convictions, actions against your previous registrations, and any history of addiction. Attach explanations where applicable.
12. Sign and date the application to certify its accuracy.
13. Once completed, save your changes, and download or print the application for submission. Ensure you send it along with the applicable payment to the designated address.

Complete your application for OBNDD registration online today!