Get Mn Request For Exemption From Reporting 2021-2025

Filling out the MN Request For Exemption From Reporting online is a straightforward process that allows facilities to request exemption from reporting to the Minnesota Prescription Monitoring Program. This guide will provide you with clear, step-by-step instructions to complete the form efficiently.

Follow the steps to complete your exemption request.

1. To begin, click the ‘Get Form’ button to access the MN Request For Exemption From Reporting form and open it in your preferred online document management tool.
2. In the first section, indicate your request for exemption from reporting to the Minnesota Prescription Monitoring Program by selecting the required option.
3. In the certification section, you must select only one option that accurately describes your facility's status, such as whether you represent an Opioid Treatment Program pharmacy or a licensed hospital pharmacy.
4. Provide any additional comments in the specified box, ensuring your response is limited to 30 characters, including spaces.
5. Enter your facility information accurately, including your MN Pharmacy License Number, DEA Number or NPI, Facility Name, Phone Number, Street Address, City, State, and Zip code.
6. Include your email address to receive a return letter if your exemption request is approved. You can also opt to receive a letter by mail only by selecting that option.
7. Next, fill in the submitter information by providing your name, title, and eSignature. Ensure you check the certification that states the information provided is true.
8. Once all fields are completed, you can either submit the form electronically or print it for your records. The options will include submitting via email or physical mail.

Complete your MN Request For Exemption From Reporting online today!