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Documents used along the form

The Controlled Substance Inventory form in Michigan is an essential document for managing and tracking controlled substances. However, it is often accompanied by several other forms and documents that help ensure compliance with state and federal regulations. Understanding these related documents can provide clarity and streamline the inventory process.

  • DEA Form 106: This form is used to report the theft or loss of controlled substances. If an inventory reveals discrepancies, this form must be completed and submitted to the Drug Enforcement Administration (DEA).
  • DEA Form 222: This form is required for the purchase and transfer of Schedule I and II controlled substances. It serves as an official order form and must be retained for record-keeping purposes.
  • Georgia WC-14 Form: This crucial document is used to notify the Georgia State Board of Workers' Compensation about a claim related to workplace injuries. Proper completion and timely submission are essential for efficient claim processing. For more information, visit Forms Georgia.
  • Biennial Inventory Form: This form documents the biennial inventory of controlled substances as required by the DEA. It ensures that a thorough inventory is conducted every two years.
  • Controlled Substance Registration Application: This application is necessary for entities seeking to register with the DEA to handle controlled substances. It includes information about the organization and its intended use of these substances.
  • Drug Enforcement Administration (DEA) Registration Certificate: This certificate confirms that a facility is authorized to handle controlled substances. It must be displayed prominently at the registered location.
  • State of Michigan Controlled Substance License: This license is issued by the state and is required for any facility or practitioner dealing with controlled substances. It ensures compliance with state laws.
  • Inventory Adjustment Form: When discrepancies arise during inventory checks, this form documents any adjustments made to the inventory records. It helps maintain accurate tracking of controlled substances.
  • Record of Disposal Form: This form is used to document the disposal of expired or unused controlled substances. It serves as a record that these substances were disposed of in compliance with regulations.
  • Controlled Substance Training Certificate: This certificate indicates that staff have completed training on the handling and management of controlled substances, ensuring compliance with safety and regulatory standards.

Each of these documents plays a crucial role in the overall management of controlled substances. Properly maintaining and utilizing these forms not only aids in compliance with legal requirements but also enhances the safety and accountability of handling these substances within the healthcare system.

Control Substance Inventory Michigan Preview

Michigan State University

Annual Controlled Substance Inventory Form

Inventory must be performed between April 1 and June 30 of each year. A separate annual inventory is required for each registered location. Mail to: State of Michigan, Bureau of Health ProfessionsHealth and Regulatory Division, Annual Inventory, 6546 Mercantile Way, Suite 2, P.O. Box 30454, Lansing, MI 48909. Retain a signed and completed copy of this form at the licensed location. The completed form can serve as the biennial inventory required by the DEA.

Date:

Start of day

End of day

MI Licensee/DEA Registrant Name:

MI Licensee/DEA Registrant Address:

DEA Registration #:

State of MI Controlled Substance ID #:

DEA Schedule*

Controlled Substance

Container Unit Type (Vial, syringe, patch, etc.)

Container Quantity

Container Volume

Concentration

*Schedule I and II controlled substances must be separated from all other substances or places on a separate form.

Inventory performed by: _________________________________

____________________________________________

Print Name

Signature

Inventory witnessed by: _________________________________

____________________________________________

Print Name

Signature

 

Page: ___ of_ __

Similar forms

The Control Substance Inventory Michigan form shares similarities with several other documents used in the management and tracking of controlled substances. Here are nine documents that are comparable:

  • DEA Form 106: This form is used to report theft or loss of controlled substances. Like the Michigan inventory form, it requires detailed information about the substances involved.
  • Biennial Inventory Form: Required by the DEA, this form is similar in purpose, as it also tracks controlled substances, but it is completed every two years instead of annually.
  • Controlled Substance Ordering System (CSOS): This electronic system allows for the ordering of controlled substances. It requires similar information about the substances being ordered, including their schedule and quantity.
  • Dispensing Records: These records document the dispensing of controlled substances to patients. They include details such as the substance name, quantity, and patient information, similar to the inventory form.
  • Promissory Note Form: Essential for documenting loans, this form serves as a written promise to pay a specific amount, similar to other accountability forms. For Minnesota-specific documentation, visit https://promissoryform.com/blank-minnesota-promissory-note/.
  • Inventory Records for Pharmacy: Pharmacies maintain these records to track their stock of controlled substances. They share the same goal of ensuring accurate accounting of these substances.
  • State Controlled Substance Registration Application: This application is necessary for facilities to register to handle controlled substances. It requires information about the substances that will be managed, akin to the inventory form.
  • Transfer of Controlled Substances Form: This document is used when transferring controlled substances between entities. It shares a focus on tracking and documenting the movement of these substances.
  • Prescription Records: These records detail the prescriptions written for controlled substances. They include similar information regarding the type and quantity of substances, ensuring compliance with regulations.
  • Monthly Controlled Substance Audit: This audit is conducted to ensure that the inventory matches the records. It serves a similar purpose to the annual inventory, providing a snapshot of controlled substance management.

Misconceptions

Misconceptions about the Control Substance Inventory Michigan form can lead to confusion and errors. Here are seven common misunderstandings:

  1. Only one inventory is needed for multiple locations. Each registered location must complete a separate annual inventory. This ensures compliance with state regulations.
  2. The inventory can be done at any time of the year. The inventory must be performed specifically between April 1 and June 30 each year. This time frame is mandated by the state.
  3. A signed copy is not necessary to keep. It is essential to retain a signed and completed copy of the form at the licensed location. This serves as proof of compliance.
  4. The form is only for state purposes. The completed form can also fulfill the biennial inventory requirement mandated by the DEA, making it useful for federal compliance as well.
  5. All controlled substances can be listed on one form. Schedule I and II controlled substances must be separated from all other substances. They require a separate form to ensure proper tracking.
  6. Witness signatures are optional. The inventory must be witnessed and signed by another individual. This adds an additional layer of verification to the process.
  7. The form does not require specific details about substances. Detailed information is necessary, including the container type, quantity, volume, and concentration of each controlled substance.

Detailed Instructions for Using Control Substance Inventory Michigan

Completing the Control Substance Inventory Michigan form is an important task that ensures compliance with state regulations. Once the form is filled out correctly, it should be mailed to the appropriate state office and a copy retained at the licensed location. This process helps maintain accurate records of controlled substances.

  1. Gather all necessary information, including the date of the inventory, your Michigan Licensee/DEA Registrant Name, and Address.
  2. Locate your DEA Registration Number and State of Michigan Controlled Substance ID Number.
  3. Identify the DEA Schedule of the controlled substances you are inventorying.
  4. List each controlled substance in the appropriate fields, including:
    • Container Unit Type (e.g., vial, syringe, patch)
    • Container Quantity
    • Container Volume
    • Concentration
  5. Ensure that Schedule I and II controlled substances are recorded separately or on a different form.
  6. Sign the form where indicated, noting your name and signature as the person performing the inventory.
  7. Have another individual witness the inventory. They should also print their name and provide their signature.
  8. Complete the page numbering at the bottom of the form (e.g., Page: ___ of __).
  9. Make a copy of the completed form for your records.
  10. Mail the original form to: State of Michigan, Bureau of Health Professions‐ Health and Regulatory Division, Annual Inventory, 6546 Mercantile Way, Suite 2, P.O. Box 30454, Lansing, MI 48909.

Dos and Don'ts

When filling out the Control Substance Inventory Michigan form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are some do's and don'ts to consider:

  • Do perform the inventory between April 1 and June 30 each year.
  • Do ensure a separate inventory is completed for each registered location.
  • Don't forget to mail the completed form to the correct address: State of Michigan, Bureau of Health Professions‐ Health and Regulatory Division, Annual Inventory, 6546 Mercantile Way, Suite 2, P.O. Box 30454, Lansing, MI 48909.
  • Don't neglect to retain a signed and completed copy of the form at the licensed location.