REGULATIONS
Vol. 35 Iss. 23 - July 08, 2019

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
DEPARTMENT OF HEALTH PROFESSIONS
Chapter 20
Forms

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.

Title of Regulation: 18VAC76-20. Regulations Governing the Prescription Monitoring Program.

Contact Information: Elaine J. Yeatts, Senior Policy Analyst, Department of Health Professions, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4688, or email elaine.yeatts@dhp.virginia.gov.

FORMS (18VAC76-20)

Request for a Waiver or an Exemption from Reporting (rev. 9/07).

Request to Register as an Authorized Agent to Receive Information from the Prescription Monitoring Program (rev. 7/08).

Pharmacist Request for Information (rev. 7/08).

Recipient Request for Discretionary Disclosure of Information from the Prescription Monitoring Program (rev. 7/08).

Prescriber Request for Discretionary Disclosure of Information from Prescription Monitoring Program (rev. 3/2009).

Request for Disclosure of Information from Prescription Monitoring Program (DHP/DDU/MEO) (rev. 7/08).

Request for Disclosure of Information from Prescription Monitoring Program for Research (rev. 7/08).

Regulatory Authority Request for Discretionary Disclosure of Information from the Prescription Monitoring Program (rev. 7/08).

Investigation under Virginia Medicaid Program; Request for Discretionary Disclosure of Information from Prescription Monitoring Program (rev. 7/08).

Prescription Monitoring Program Internet Datacenter Registration Form (rev. 7/08).

Request for a Waiver or an Exemption from Reporting (rev. 5/2018)

Request for a Waiver or an Exemption from Reporting: Veterinarian (rev. 5/2018)

Request to Register as an Authorized Agent to Receive Information from the Prescription Monitoring Program (rev. 7/2017)

Recipient Request for Discretionary Disclosure of Information from the Prescription Monitoring Program (rev. 7/2017)

Regulatory Authority Request for Discretionary Disclosure of Information from the Prescription Monitoring Program (rev. 4/2018)

Application to Register as a Virginia Medicaid Managed Care Authorized Agent to Receive Information from Prescription Monitoring Program (rev. 4/2018)

Account Development Form for Reporting to Virginia’s Prescription Monitoring Program (rev. 7/2018)

Request to Register as an Authorized Parole or Probation Officer to Receive Information from the Prescription Monitoring Program (rev. 4/2018)

Request to Register as an Authorized Drug Diversion Investigator to Receive Information from the Prescription Monitoring Program (rev. 4/2018)

VA.R. Doc. No. R19-6038; Filed June 7, 2019, 2:46 p.m.