Get Va Northern Virginia Ems Council Regional Controlled Substance Kit Exchange Form 2020-2025

Filling out the VA Northern Virginia EMS Council Regional Controlled Substance Kit Exchange Form online is essential for accurate record-keeping and compliance. This guide provides step-by-step instructions on how to complete each section of the form effectively and accurately.

Follow the steps to complete the form accurately and efficiently.

1. Click the ‘Get Form’ button to access the form and open it in your chosen platform.
2. Begin by filling in the initial CSK Number at the top of the form. This number is crucial for tracking the exchange process.
3. In the medications section, list the amount ordered for each medication specified, including , , , and . Ensure that the amounts correspond with what is contained in your controlled substance kit.
4. Next, enter the amount given for each medication. This field is vital for inventory tracking and accountability.
5. Record the name of the provider administering the medications by printing their name clearly in the designated field.
6. Fill in the details for the EMS CSK Replacement, including the administering provider's unit number and the issuing facility.
7. After issuing the medications, document the patient name and date of birth in the appropriate fields, ensuring all information is accurate.
8. Indicate the amount wasted and the name of the waste witness, if applicable, to maintain transparency in the process.
9. Select the reason for replacement by checking the relevant box. This section should clarify why a replacement is necessary.
10. Complete the fields for accepting signatures, including the EMS attendant in charge, co-sign, and accepting healthcare providers, ensuring all printed names are legible.
11. Lastly, ensure that all signatures are complete, and fill in the hospital medical record number before saving the form.
12. Once you have filled out the form, review it for any errors. You can then save changes, download, print, or share the completed document as needed.

Take action now and complete your VA Northern Virginia EMS Council Regional Controlled Substance Kit Exchange Form online.