Get Fl Dh8010-pdmp 2019-2026

Filling out the FL DH8010-PDMP form online is a straightforward process designed to appoint an administrator for the Florida Prescription Drug Monitoring Program. This guide will help you navigate each section of the form with clarity and ease, ensuring that you provide all necessary information accurately.

Follow the steps to complete the FL DH8010-PDMP form online:

1. Click the ‘Get Form’ button to access the FL DH8010-PDMP form for online completion.
2. Indicate whether you are making a new appointment or removing an existing appointment by selecting the appropriate option.
3. Enter the effective date for the change in agency administrator status.
4. Fill in your agency's name as well as your name, title, employee ID number, telephone number, and email address.
5. If applicable, indicate your undercover status to assert public record exemption by marking 'Yes' or 'No'.
6. Initial the statements confirming the accuracy of your information, your understanding of the confidentiality of the information, and your obligation to maintain its confidentiality.
7. Provide your electronic signature in the designated format, followed by the date.
8. Complete the agency head or designee section with their name, title, phone number, and email address, and ensure they also sign and date the form.
9. Once all fields are completed, save your changes and proceed to download, print, or share the completed form.

Start filling out your FL DH8010-PDMP form online today.