Appendix 9998. 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. 7/08).

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).