Get Individuals Controlled Substance Prescription History Report Request

Filling out the Individuals Controlled Substance Prescription History Report Request online allows individuals to efficiently manage their prescription history. This guide provides clear, step-by-step instructions to ensure a smooth completion process.

Follow the steps to successfully submit your request.

1. Click ‘Get Form’ button to obtain the request form and open it in the designated editor.
2. In Section 1, provide the subject's full name, date of birth, address, phone number, city, state, and zip code. Ensure that all details are accurate to avoid any delays.
3. In Section 2, indicate the release information from the Minnesota Prescription Monitoring Program. Confirm the agency name if applicable.
4. In Section 3, fill in the release information to. Provide the recipient's name, address, phone number, email address, and the purpose of the use. The recipient must be a named individual, not an agency or business.
5. In Section 4, familiarize yourself with your rights. Indicate your awareness of the information being released and sign to certify that you understand the implications of your request.
6. Make sure to sign and date the form in the presence of a notary public. This step is critical, as unsigned forms will be returned.
7. Review the entire form for completeness. Incomplete forms will not be processed.
8. After completing the form, submit your request by mail, fax, or email to the Minnesota Board of Pharmacy at the provided address.

Start your document submission process online today.