Get Hospital Application For Registration (form Dhhs 224-a)

Completing the Hospital Application For Registration (Form DHHS 224-A) is an essential step in ensuring that your facility complies with state and federal regulations regarding controlled substances. This guide provides clear and concise instructions to assist you in successfully filling out the form online.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it in the online editing tool.
2. Begin with Section A: Applicant Information. Fill in the facility name, address, county, city, zip code, phone number, mailing address, and number of beds. Ensure all fields are completed; if a field is not applicable, denote with 'N/A'.
3. In Section B: Registration Classification, check all applicable drug schedules that you are applying for. Respond to the questions regarding current authorizations and past convictions related to controlled substances.
4. Proceed to Section C: Point of Contact. List up to three contact persons who can assist during the inspection process, providing their names, titles, emails, and phone numbers.
5. In Section D: State Registration History, identify the reason for the application and provide relevant information based on the event selected, such as anticipated opening date or previous registration details.
6. For Section E: Drug Enforcement Administration (DEA) Registration, indicate whether the applicant currently possesses any controlled substances and provide details of the DEA registration status.
7. Complete Sections F through Y by providing information about suppliers, pharmacy staffing, security measures, and procedures regarding the storage, dispensing, and administration of controlled substances.
8. In Section Z: Effective Controls for the Prevention of Diversion, describe measures taken to prevent diversion of controlled substances, including software reporting systems and review processes.
9. Finally, review the entire form for accuracy. Make sure all sections are filled completely, save your changes, and prepare to submit the form online.
10. Submit the completed form via email, along with any required documents and the nonrefundable application fee of $300. Remember to attach a signed PDF copy of an Applicant Disclosure of Loss, Diversion, or Destruction of Controlled Substances.

Complete your application for registration online today to ensure your facility is compliant with regulations.