TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
DEPARTMENT OF HEALTH PROFESSIONS
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, General Assembly Building, 201 North Ninth Street, Fourth Floor, Richmond, Virginia 23219.
Title of Regulation: 18VAC76-20. Regulations Governing the Prescription Monitoring Program.
Agency Contact: Erin Barrett, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4688, or email erin.barrett@dhp.virginia.gov.
FORMS (18VAC76-20)
Request for a Waiver or an Exemption from Reporting (rev. 10/2019)
Request for a Waiver or an Exemption from Reporting: Veterinarian (rev. 10/2019)
Request to Register as an Authorized Agent to Receive Information from the Prescription Monitoring Program (rev. 4/2018)
Recipient Request for Discretionary Disclosure of Information from the Prescription Monitoring Program (rev. 9/2021)
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 Clinical Designee to Receive Information from the Prescription Monitoring Program (rev. 4/2018)
Application to Register as a Virginia Medicaid Managed Care Authorized Agent to Receive Information from the 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)
Request to Register as an Authorized Investigator for the Department of Corrections to Receive Information from the Prescription Monitoring Program (eff. 8/2019)
Recipient Request Form (rev. 6/2023)
Dispenser Registration Form for Prescription Monitoring Program Reporting Account (rev. 1/2022)
Request for a Waiver or an Exemption from Reporting (rev. 2/2022)
Request for a Waiver or an Exemption from Reporting for Veterinarians (rev. 7/2024)
VA.R. Doc. No. R24-7990; Filed July 08, 2024