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  • 34617.pdf. State Application Indiana Controlled Substances Registration

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For official use only STATE APPLICATION INDIANA CONTROLLED SUBSTANCES REGISTRATION CSR No. State Form 34617 (R11 / 697) Approved by State Board of Accounts, 1996 Receipt No. Health Professions Bureau.

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ACTIVE INDIANA LICENSE: Applicants must have an active Indiana dental license before they can obtain an Indiana CSR. A dentist must hold one CSR in order to prescribe, administer & dispense controlled substances in the State of Indiana.

A prescription for a controlled substance must be issued for a legitimate medical purpose in a reasonable quantity by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing is upon the prescribing practitioner.

Indiana considers not only well-known drugs like marijuana, heroin, and cocaine to be controlled substances but also the compounds used to manufacture them. Some controlled substances, like codeine, may be legally possessed with a valid prescription.

Renew online at mylicense.in.gov using the credentials you created for your primary license. To renew by mail, send this form with the renewal fee of $60.00 to the address above, allowing 4 weeks for processing. Make check or money order payable to 'Indiana Professional Licensing Agency'.

Schedule I Drugs: Examples include heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3, 4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.

Explaining the prescription paper requirements Safety Requirements: A latent, repetitive “void” pattern in reflex blue must appear across the entire face of the document when the prescription is photocopied.

(h) A prescription is valid for not more than one (1) year after the original date of issue. (i) A pharmacist may not knowingly dispense a prescription after the demise of the practitioner, unless in the pharmacist's professional judgment it is in the best interest of the patient's health.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232