Dispensing Practitioner Inspection - Nevada State Board of Pharmacy

Nevada State Board of Pharmacy431 W. Plumb Lane Reno, Nevada 89521(775) 850-1440 (800)-364-2081 Fax (775) 850-1444Does the practitioner maintain the dispensing records properly &retain them for 2 years? Yes NoDoes the facility maintain these records on site? 21 CFR 1304.04 (a) Yes NoDoes the facility dispense controlled substances? (if NO skip to security section) Yes NoDoes the facility dispense schedule 2 substances? (if YES) Yes NoAre schedule II prescriptions filed separately from allother prescriptions? Yes NoDoes the facility participate in the Controlled SubstanceOrdering System (CSOS) for Schedule 2 controlled substances?Are schedule 2 order forms properly completed? 21 CFR 1305.06 Yes NoAre schedule 2 records of receipt (invoices) filed separate from all other invoices?NAC 453.410 Yes NoDoes the facility dispense schedule 3-5 controlled substances? Yes NoAre schedule III-V records of receipt (invoices) filed separately from all other records?NAC 453.410 Yes NoHow are schedule III-V prescriptions filed NAC 453.480/21 CFR 1304.04 (h)]YesNo(single file) (separate file)circle method of filingIf in single file: are controlled prescriptions marked in a way tobe readily retrievable? Yes NoHas a biennial inventory of controlled substances been completed? 21 CFR 1304.11, NRS 453.246Biennial Inventory date or n/a:_______________________________ Yes NoDoes facility report all controlled substances dispensed weeklyto Nevada controlled substance task force? Yes NoYou are required to submit electronically, weekly, data on all controlled substances dispensed to the PrescriptionControlled Substance Abuse Prevention Taskforce Phone: 775-687-5694Email: ladams@pharmacy.nv.gov How are you submitting the required data?SECURITY NAC 453.400, NAC 639.285, NAC 639.898, NAC 639.520:Are controlled substances/dangerous drugs kept in a deadbolt lockedstorage area? Yes NoAre licensed practitioner(s) the only person(s) with possession of a key? (review dispensing practitioner regulationsfor when a dispensing technician may possess the key to the medications)YesNoDoes the facility have an alarm system? (recommended)Provider:_______________________________________ Yes NoIf dispensing controlled substances:Has there been any theft or loss of controlled substances sincethe last inspection? Yes No(if YES): Was the theft or loss of controlled substancesproperly reported to NSBP, DEA, NDPS? NRS 453.568Are proper drug destruction procedures followed?21 CFR 1307.21, NAC 639.050 Yes NoYesNoIs access to the controlled substance task force data base limited to the practitioner?Yes NoHow is the access protected?Nevada State Board of Pharmacy Practitioner Dispensing Inspection For 4/8/2014 Page 4 of 8