Rule 4729:5-10-06 | Donor and recipient forms.
(A) Each donor must sign an electronic or physical form stating that the donor is the owner of the drug and intends to voluntarily donate the drug to the drug repository program. The donor form must be completed prior to any donation and include at least the following:
(1) The name of the person that was originally dispensed the drugs or the name of the entity that owns the drugs.
(2) The full name, contact phone, and signature of the donor, which may include any of the following:
(a) The person designated by durable power of attorney, a guardian, an individual responsible for the care and well-being of a patient;
(b) The executor, administrator, or trustee of the estate of a deceased patient;
(c) The responsible person or the responsible person's designee of a terminal distributor of dangerous drugs or a drug distributor;
(d) The licensed prescriber or pharmacist responsible for the oversight of the entity donating the drug.
(3) The address of the donor or the entity donating the drug.
(4) The date the form was signed.
(B) The following donor information must also be documented. This information may be documented on the original signed donor form or on an alternate record created by the repository program. If an alternate record is used, the record must include the name of the donor in addition to the required information in this paragraph.
(1) The brand name or generic name of the drug donated and either the name of the manufacturer or the national drug code number (NDC#).
(2) The strength of the drug donated.
(3) The quantity of the drug donated.
(4) The date the drug was donated.
(C) Prior to receiving donated drugs from a drug repository program, each recipient must sign an electronic or physical form stating they understand the immunity provisions of the program pursuant to division (B) of section 3715.872 of the Revised Code.
(D) Donor forms shall be maintained for a minimum of three years in a readily retrievable manner by the repository program.
(E) Recipient forms shall be maintained for a minimum of three years in a readily retrievable manner by the repository program.
(F) A prescriber shall document the distribution of a personally furnished donated repository program drug to the prescriber's patient pursuant to the applicable record keeping rules of division 4729:5 of the Administrative Code and a pharmacy shall document the dispensing of a donated repository program drug pursuant to the applicable record keeping rules of division 4729:5 of the Administrative Code. Such records shall indicate that the drug distributed to a patient was from a repository program. If recipient forms are used with each dispensing or personal furnishing, this information may be documented on the recipient form.
Last updated May 30, 2023 at 8:28 AM
Supplemental Information