Pharmaceutical Request Form

Instructions

Pharmaceutical Request Forms are used when an investigator needs to procure a pharmaceutical agent for use on an IACUC approved protocol. Please allow 1 week to obtain these pharmaceuticals.

All Controlled Substances require a DEA Registration Number and must be picked up and signed for by the faculty member associated with the project who is a DEA registrant. A University ID is required at the pick up.

Schedule II pharmaceuticals (Codeine, Fatal Plus, Fentanyl, Hydrocodone/Homatropine, Hydromorphone, Methadone, Morphine, Pentobarbital, Remifentanil) require that Form 222 in the name of the DEA registrant be brought to the pharmacy at the time of pick up. These may be ordered by the DEA registrant at the link below.

Order Forms Request

Principal Investigator*

First Last

Email*

Enter Email Confirm Email

Department*

IACUC PRN*

UVIS Account Number

DEA Registration Number

For controlled substances only

Pharmaceutical Needed*

Concentration*

Amount*

(i.e., 20 cc bottle, 2 cc syringe)

Date the Pharmaceutical is Needed*

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Instructions

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