Showing posts with label forms. Show all posts
Showing posts with label forms. Show all posts

Wednesday, July 14, 2021

Wholesaler Self-Assessments Due Before July 1

Updated May 23, 2026

Self-Assessment Forms

California State Board of Pharmacy

Has your facility completed a self-assessment form? 

PICs are required to complete a self-assessment before July 1 of each odd-numbered year. 

View the current self-assessment forms and updated self-assessment draft forms. Although licensees are required to complete currently adopted self-assessment forms, either the current or draft forms are acceptable.

Return Home:  The Designated Representative and Exemptee Blog

- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Saturday, July 27, 2019

Wholesaler Dangerous Drugs & Dangerous Devices Self-Assessment Forms

Go to the webpage:
Wholesaler Dangerous Drugs & Dangerous Devices Self-Assessment Forms - California State Board of Pharmacy

According to the Board:

"The assessment shall be performed before July 1 of every odd-numbered year. The self-assessment forms must remain on-site at the facility. Only submit the form to the board if requested by board staff. 
The board is in the process of updating the Self-Assessment forms through a formal rulemaking.  The updates include references to statutory and regulatory changes that occurred between 2014 and 2016.  The last time the forms were formally updated was 2014. 
Current regulation requires a pharmacy or wholesaler to complete the 2014 version of the Self-Assessment form.  Please be advised, however, the board will accept completion of either the 2014 version OR the 2016 version.  The latter version is likely to be a more helpful assessment to the pharmacy or wholesaler completing it."

Return Home:  The Designated Representative and Exemptee Blog

--------------

California Designated Representative Training Program for Wholesalers. Board-approved. Earns a training affidavit accepted by the Board.
California Designated Representative Training Program for Wholesalers. Board-approved. Earns a training affidavit accepted by the Board.

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, April 26, 2016

Self-Assessment Forms - Current Versions - CA St Board of Rx

Updated September 27, 2025

Follow this link to the current collection of:


- -  original post follows below  - -

The California Board of Pharmacy announced*:

"Board regulations (Title 16 California Code of Regulations sections 1715 and 1784), require that all licensed pharmacies and wholesalers complete a Self-Assessment by July 1 of every odd-numbered year.

The board recently updated the Self-Assessment forms through a formal rulemaking. The updated forms contain references to statutory and regulatory changes that occurred between 2011 and 2014 (inclusive).

While the rulemaking process was underway, the board accepted from pharmacies, hospital pharmacies and wholesalers completion of either the 2011 version OR the draft 2014 version: both versions have been available for use on the board’s website.

On April 20, 2016, the Office of Administrative Law approved the revised self-assessment forms. These forms can be downloaded at: http://www.pharmacy.ca.gov/licensees/facility/self_assess.shtml  They will all have “(Rev. 10/14)” date on them in in the lower left corner of the pages.

Form 17M-13: “Community Pharmacy Self-Assessment/Hospital Outpatient Pharmacy Self‐Assessment (Rev. 10/14)”
Form 17M-14: “Hospital Pharmacy Self‐Assessment (Rev. 10/14)”
Form 17M-26: Form 17M-26: “Wholesaler Dangerous Drugs & Devices Self-Assessment (Rev. 10/14).”

The board encourages all pharmacies, hospital pharmacies and wholesalers to complete the revised forms if they have not already completed the 2014 assessments. The board will no longer accept the 2011 versions of the self-assessment forms as [compliant]."

* Source:
California State Board of Pharmacy Subscriber Alert - emailed to PHARM-GENERAL@DCALISTS.CA.GOV on April 25, 2016.

Return Home:  The Designated Representative and Exemptee Blog

-----------

California Designated Representative Training Courses (wholesaler, 3PL) - Approved by the California State Board of Pharmacy
California Designated Representative Training Courses (wholesaler, 3PL) - Approved by the California State Board of Pharmacy

- - -


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, April 19, 2016

HMDR Licensing - 30% Fee Increase

Updated March 25, 2023

The original link broke.

You can find the current fee schedule PDF on the HMDR Program Home Page
as "HMDR License Fees."

---  the original post follows below  ---

Go to the announcements on: HMDR Licensing Program Home Page:

"News, Hot Topics, & Updates:

HMDR License Fees (Effective July 1, 2016)"

'via Blog this'

In a nutshell:
Effective July 1, 2016, the California Department of Public Health (CDPH), Food and Drug Branch (FDB) licensing fees will increase by 30 percent pursuant to the California Health and Safety (H&S) Code Sections 111630 and 111656.1 authorizing CDPH to establish and adjust licensing fees to cover the estimated program costs.

Return Home:  The Designated Representative and Exemptee Blog




- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Monday, June 8, 2015

CA Board of Pharmacy - Self-Assessment Forms

Updated May 13, 2025:

CA Board of Pharmacy Self-Assessment Forms

Follow the Board's instructions on which versions of the forms posted on the Board's website that should be used:

CA Board of Pharmacy - Self-Assessment Forms


---  The original post below is outdated --- 

Go to the links for all forms: Board of Pharmacy - Applications and Forms - California Board of Pharmacy:

"Self-Assessment Forms

Board regulations require that all licensed pharmacies and wholesalers complete a Self-Assessment by July 1 of every odd-numbered year.

The board is in the process of updating the Self-Assessment forms through a formal rulemaking.  The updates include references to statutory and regulatory changes that occurred between 2011 and 2015.  The last time the forms were formally updated and approved by the Office of Administrative Law was 2011.

Current regulation requires a pharmacy or wholesaler to complete the 2011 version of the Self-Assessment form.  Please be advised, however, the board will accept completion of either the 2011 version OR the 2014 version.  The latter version is likely to be a more helpful assessment to the pharmacy or wholesaler completing it."

'via Blog this'

Return Home:  The Designated Representative and Exemptee Blog

-----------------

California Designated Representative Training Courses (wholesaler, 3PL) - Approved by the California State Board of Pharmacy
California Designated Representative Training Courses (wholesaler, 3PL) - Approved by the California State Board of Pharmacy



For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Wednesday, June 19, 2013

CA HMDR Licensing - Info - Forms - FAQs

HMDR Licensing Program Home Page:

"The HMDR program is mandated by Assembly Bill 1496 of the 1999-2000 legislative session. This program licenses California HMDR facilities and registers Out-of-State HMDR facilities. In-State HMDR facilities supply prescription medical devices or durable medical equipment for use in the home to treat acute or chronic illnesses or injuries. Out-of-State HMDR facilities must supply prescription medical devices in order to qualify for the registration. The HMDR program also licenses exemptees that are required to be on staff in lieu of a pharmacist at facilities selling prescription medical devices as described under California and Federal medical device laws."

Return Home:  The Designated Representative and Exemptee Blog

- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, June 5, 2012

New 2012 CA Rx Law - Security Prescription Forms for Controlled Substances

Updated November 20, 2025

The lawbook gets updated annually, so the page references change.

Here's the link to the current California Pharmacy lawbook:
http://www.pharmacy.ca.gov/laws_regs/lawbook.pdf

HSC section 11162.1 is somewhere near page 743.

---  previous updates follow below  ---

Updated December 15, 2017

You might have also been looking for this, recently emailed out in a Nov 28, 2017 subscriber alert by the CA BOP.

"Background:

California Health and Safety Code section 11162.1 contains 14 elements that must appear on California Security Forms, the forms used to prescribe controlled substances in California*.  These elements were first enacted in 2003 when the triplicate prescription form was discontinued.  The law also requires that California Security Forms must be printed by CA Department of Justice licensed printers.  In 2006, the law was amended again to make several changes that took effect in January 2007.  Finally legislation enacted in 2011 required that the California Security Forms in use must be fully compliant with all requirements of the Health and Safety Code by July 1, 2012.

Here is a link to the required elements in the Health and Safety Code (go to page [718]):  http://www.pharmacy.ca.gov/laws_regs/lawbook.pdf

In recent years, the board has continued to identify noncompliant California Security Forms in use that have been filled by California pharmacies, in violation of the Health and Safety Code requirements.  The board’s response upon identification of noncompliant forms having been used to dispense controlled drugs is to educate the licensee, and to cite and fine the pharmacy/pharmacists involved. Typically the licensing board for the prescriber is advised as well. 

Recently some pharmacies have begun to refuse to fill prescriptions written on noncompliant forms where item 11162.1(a)(10) is not fully compliant with the required elements.  One of these elements is “ Check boxes shall be printed on the form so that the prescriber may indicate the number of refills ordered.”  There are also additional elements missing on some forms, including lack of a watermark on the reverse of the form.   

The board recently has received complaints from patients or prescribers whose patients have been denied medication from the pharmacy because of the noncompliant forms.

Interim Solutions
  • Prescribers and dispensers need to become familiar with the 14 required elements of the security prescription  forms.
  • Prescribers with noncompliant forms should reorder compliant forms from a DOJ-licensed security printer.
  • Prescribers with noncompliant forms should consider using e-prescribing for controlled substances."

- -  the original post follows below  - -

This was just sent out by the California State Board of Pharmacy.  It's important enough, that you should stop to read this, and make sure your policies and procedures are in compliance with the new laws.

According to the Board:

This is a reminder about a new law taking effect July 1, 2012 regarding the required elements for security forms for controlled substances:

Effective January 1, 2012, security prescription forms for controlled substances must include the preprinted address of the prescriber (Health and Safety Code section 11162.1). Security prescription forms that do not have the preprinted address of the prescriber can be dispensed by the pharmacist until July 1, 2012. Prescription forms not in compliance are invalid and cannot be accepted on or after July 1, 2012.

Additionally, licensed health care facilities or clinics exempt under Section 1206 (those having 25 or more licensed physicians or surgeons preprinted on the form) are not required to preprint the category of licensure and license number of their facility or clinic (Health and Safety Code 11162.1[c][2]).

View all changes in Pharmacy Law that took effect in 2012 by using this link: http://www.pharmacy.ca.gov/laws_regs/new_laws.pdf

Return Home:  The Designated Representative and Exemptee Blog


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):


Tuesday, November 8, 2011

CA Designated Representative Licensee Info

Updated July 19, 2016

The Board's website has been redesigned.  Therefore, the link in the original post has broken; and the related four informational areas have changed and appear in new and different places on the website.

Here's the link to the CA Board of Pharmacy website

- - - original post follows below - - -

Designated Representative (formerly called Exemptee) - CA Board of Pharmacy Information for Licensees directs you to these four (4) informational areas:
  1. Cancellation of Permit 
  2. Change of Designated Representative-in-Charge (PDF) 
  3. Name/Address Change 
  4. Renewal of Permit

----------

California Board of Pharmacy Designated Representative Training - for 3PL, wholesalers, reverse distributors. Board-approved.
California Board of Pharmacy Designated Representative Training - for 3PL, wholesalers, reverse distributors. Board-approved.

- - -


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, July 21, 2009

CA - Forms for Drug Wholesalers and Designated Representatives

Updated June 10, 2026

There will be times when you need to submit new or revised forms to the CA State Board of Pharmacy. Here's a collection of forms that might be useful to drug wholesalers, and designated representatives.

Just a tip, make sure to pay attention to the requirements for when some of these forms need to be submitted. For example, changes in the designated representative in charge need to be reported within 30 days of a change.

Go to the California Board of Pharmacy - forms for applicants


Return Home:  The Designated Representative and Exemptee Blog

----------------------

The largest selection of Board-approved California Designated Representative online training programs. 3 distinct training courses for wholesalers, 3PL, reverse distributors. Earns a Board-recognized training affidavit.
The largest selection of Board-approved California Designated Representative online training programs. 3 distinct training courses for wholesalers, 3PL, reverse distributors. Earns a Board-recognized training affidavit.


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Custom Search

From SkillsPlus International Inc.