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Prescription Fraud Report
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Prescription Fraud Report

Please complete the information below.  (*) indicates a required field.  Because of liability concerns, do NOT include suspect name(s), however, do include all available descriptive information to help pharmacy personnel to identify potential suspect(s).

Example description: 40 yo Caucasian male. Approx 200 lbs, 6 ft tall. Brown hair, brown eyes.
Calling in Rxs for hydrocodone and Xanax     << insert other descriptive text as appropriate >>
 
This information will be distributed to our members in the next edition of our e-newsletter.



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