Get Ia Petition For Exemption From Mandate For Electronic Transmission Of Prescriptions 2019

This guide provides clear and comprehensive instructions for completing the IA Petition For Exemption From Mandate For Electronic Transmission Of Prescriptions. By following these steps, you can successfully submit your petition to the Iowa Board of Pharmacy while ensuring you meet all necessary requirements.

Follow the steps to efficiently complete your petition for exemption.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of your request in the designated field. Ensure that the date is formatted as MM/DD/YYYY.
3. Indicate the duration of the exemption requested, noting that it cannot exceed one year.
4. Fill in the name of the entity or provider seeking the exemption. Be specific and avoid abbreviations.
5. Select the type of entity business you operate. Provide accurate information that reflects your business structure.
6. If applicable, include your provider CSA number in the appropriate field.
7. Provide the complete address of your entity or provider, ensuring that all components (street, city, state, and zip code) are accurately filled.
8. Complete the contact name and their phone number, followed by an email address you wish to be contacted through.
9. Answer the questions regarding whether you prescribe controlled or non-controlled substances, including the approximate number of prescriptions written in 2019.
10. Describe the types of controlled and non-controlled substances you generally prescribe in the provided fields.
11. Indicate your current capability to electronically prescribe controlled and non-controlled substances; answer with either 'yes' or 'no'.
12. If you have plans to implement electronic prescribing, specify when you expect to do so, and confirm the capabilities of the platform.
13. Provide a detailed explanation of the exemption you are seeking and the reasons justifying your request.
14. Outline your plan in the event that your petition is denied.
15. Select the appropriate category that most accurately matches the reason for your petition from the provided options.
16. If applicable, specify details regarding renewal of a previously approved exemption and the progress made toward compliance.
17. Review all entered information for accuracy and completeness before submission.
18. Once satisfied with the form's contents, proceed to save any changes, download, print, or share your completed petition as necessary.

Take action today and complete your IA Petition For Exemption From Mandate For Electronic Transmission Of Prescriptions online.