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Fill Your Texas Nar 115 Form

The Texas Nar 115 form is a document used for the modification of registration under the Texas Controlled Substances Act. It is essential for Emergency Medical Services (EMS) providers to update their registration information, particularly regarding their Medical Director. Accurate completion of this form ensures compliance with state regulations and facilitates the proper handling of controlled substances.

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Dos and Don'ts

When filling out the Texas Nar 115 form, it's crucial to be thorough and accurate. Here are some important dos and don’ts to keep in mind:

  • Do ensure that all information is current and correct before submission.
  • Do provide a complete EMS business address; avoid using a PO Box.
  • Do check all applicable drug schedules that pertain to your registration.
  • Do include both the old and new information for the Medical Director clearly.
  • Do sign and date the form in the appropriate sections.
  • Don't leave any fields blank; every section must be filled out.
  • Don't use abbreviations or shorthand; clarity is essential.
  • Don't forget to include phone numbers for both the Medical Director and EMS Administrator.
  • Don't submit the form without double-checking for typos or errors.
  • Don't ignore the submission guidelines; follow the instructions for mailing or faxing carefully.

By following these guidelines, you can help ensure a smooth and efficient registration process.

Sample - Texas Nar 115 Form

Modification of Registration-EMS

under

Texas Controlled Substances Act

EMS Registration Information

___________________

___________________

______________________

DPS Number

DEA Number

DSHS Board License Number

Old Information(Medical Director)

______________________________________________________________________________________

Name (Last, First, Middle)

Degree

TX Medical Board # Personal DPS Number

_________________________________________________________________

EMS Business Address

 

 

_________________________________________________________________

_________________________________________________________________

City, State, Zip

New Information(Medical Director)

______________________________________________________________________________________

Name (Last, First, Middle)Degree TX Medical Board # Personal DPS Number

_________________________________________________________________

EMS Business Address (Cannot accept a PO Box number only)

_________________________________________________________________

_________________________________________________________________

City, State, Zip

Drug Schedules (Check all applicable)(2) Schedule II

(2N) Schedule II-Non-Narcotic

(3) Schedule III

(3N) Schedule III-Non-Narcotic

(4) Schedule IV

(5) Schedule V

Signature

__________________________

(

)_____________

_____________________

Signature of Medical Director

Phone Number

Date

Signature

 

 

 

__________________________

(

)_____________

_____________________

Signature of EMS Admin.

Phone Number

Date

Notice: Signature of applicants certifies that the above information is current and correct. Signature of applicant further grants the director or his designee the right to inspect controlled premises or records to be kept by the Texas Controlled Substances Act of 1973.

Return to: Controlled Substances Registration MSC-0438, PO Box 4087, Austin, Texas, 78773-0438 Or fax to 512/424-5799

NAR-115 (5/10)

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Documents used along the form

The Texas Nar 115 form is essential for modifying registration under the Texas Controlled Substances Act. However, several other forms and documents are commonly used alongside it to ensure compliance with state regulations. Below is a list of these documents, along with brief descriptions of each.

  • Texas Controlled Substance Registration Application: This form is used to apply for a new registration to handle controlled substances in Texas. It provides essential details about the applicant and the substances they intend to manage.
  • Texas Drug Enforcement Administration (DEA) Registration: This document is necessary for organizations that wish to prescribe, distribute, or dispense controlled substances. It ensures compliance with federal regulations.
  • Texas Medical Board License Application: Required for healthcare professionals, this application verifies that the individual is licensed to practice medicine in Texas and is in good standing with the medical board.
  • Controlled Substance Inventory Form: This form is used to document the quantities and types of controlled substances on hand. It helps maintain accurate records for audits and inspections.
  • Emergency Medical Services (EMS) Provider License Application: This application is necessary for EMS providers to operate legally in Texas. It includes information about the organization and its personnel.
  • Drug Schedule Declaration: This document outlines the specific schedules of controlled substances that the applicant intends to handle. It helps clarify the scope of the registration.
  • Incident Report Form: In the event of any issues related to controlled substances, this form documents the incident and is submitted to the relevant authorities for review.
  • Employee Training Records: These records demonstrate that employees have received proper training on handling controlled substances. They may be requested during inspections to ensure compliance with safety regulations.

Using these documents in conjunction with the Texas Nar 115 form helps ensure that all legal requirements are met when handling controlled substances in Texas. Proper documentation is crucial for maintaining compliance and promoting safety within the healthcare system.

Common mistakes

Filling out the Texas NAR 115 form can be straightforward, but there are common mistakes that applicants often make. One major error is failing to provide complete information. Each section of the form requires specific details, such as the name and license numbers of the medical director. Omitting any of this information can delay the processing of the application.

Another frequent mistake is using a P.O. Box for the EMS business address. The form explicitly states that only a physical address is acceptable. Submitting a P.O. Box can lead to rejection of the application, as it does not meet the requirements outlined in the form.

Additionally, applicants sometimes neglect to check the appropriate drug schedules. It’s important to carefully review and mark all applicable schedules, as this directly impacts the registration. Incorrectly indicating the drug schedules can lead to complications down the line, including potential legal issues.

Lastly, signatures can be a point of confusion. Both the medical director and the EMS administrator must sign the form. Failing to include one of these signatures can result in the application being incomplete. Always double-check that all required signatures are present before submitting the form.

Misconceptions

The Texas Nar 115 form is often misunderstood. Below are ten common misconceptions regarding this form.

  • It is only for new EMS registrations. The Nar 115 form is also used for modifications to existing registrations, not just for new applications.
  • Only the EMS administrator can fill out the form. While the EMS administrator typically submits the form, it can also be filled out by the medical director or other authorized personnel.
  • PO Box addresses are acceptable. The form specifically states that only physical addresses are acceptable, and PO Box numbers cannot be used.
  • All drug schedules must be checked. Only the applicable drug schedules need to be checked. It is not mandatory to select all options.
  • The signatures are optional. Signatures are required to certify the accuracy of the information provided on the form.
  • Submission can be done in any format. The form must be submitted via mail or fax as specified in the instructions; other submission methods are not accepted.
  • The form does not require a phone number. Both the medical director and EMS administrator must provide their phone numbers on the form.
  • Once submitted, the information cannot be changed. Modifications can be made by submitting a new Nar 115 form if changes are necessary.
  • Only licensed medical directors can sign the form. While a licensed medical director typically signs, other authorized personnel may also sign if permitted by the EMS organization.
  • There are no penalties for incorrect information. Providing false or misleading information can lead to penalties under the Texas Controlled Substances Act.

Key takeaways

When filling out and using the Texas Nar 115 form, it is essential to keep the following key points in mind:

  • Accurate Information: Ensure all information provided, including names and addresses, is accurate and up-to-date.
  • Medical Director Details: Clearly distinguish between the old and new Medical Director information, including degrees and license numbers.
  • No PO Box: The EMS Business Address must be a physical location; PO Box addresses are not accepted.
  • Drug Schedules: Check all applicable drug schedules to ensure compliance with regulations.
  • Signatures Required: Both the Medical Director and EMS Administrator must sign the form, including their phone numbers and dates.
  • Submission Method: Return the completed form by mail or fax to the specified addresses to ensure timely processing.

Completing this form accurately is crucial for compliance with the Texas Controlled Substances Act. Delays or errors can lead to significant issues in registration and operational capacity.

File Characteristics

Fact Name Description
Form Purpose The Texas Nar 115 form is used to modify registration for Emergency Medical Services (EMS) under the Texas Controlled Substances Act.
Governing Law This form is governed by the Texas Controlled Substances Act, specifically under Title 6, Chapter 481 of the Texas Health and Safety Code.
Information Required Applicants must provide both old and new medical director information, including names, degrees, and Texas Medical Board numbers.
Address Requirements The EMS business address must be a physical location; PO Box numbers are not accepted.
Drug Schedules Applicants must indicate applicable drug schedules by checking the appropriate boxes, including Schedule II, III, IV, and V.
Signatures Required The form requires signatures from both the medical director and the EMS administrator, along with their phone numbers and dates.
Certification Notice By signing, applicants certify that the information provided is accurate and grant inspection rights to the director or designee.
Submission Methods The completed form can be mailed to a specified address or faxed to the provided number.
Form Version The current version of the Nar 115 form is dated May 2010.
Contact Information For inquiries, applicants may contact the Texas Department of Public Safety regarding the registration process.

How to Use Texas Nar 115

Once you have gathered the necessary information, you can begin filling out the Texas Nar 115 form. Make sure to provide accurate details, as this information is crucial for your registration modification. Follow these steps carefully to complete the form.

  1. Start by entering your EMS Registration Information at the top of the form. Fill in the DPS Number, DEA Number, and DSHS Board License Number.
  2. In the section for Old Information (Medical Director), write the name of the current Medical Director. Include their last name, first name, and middle name.
  3. Provide the Medical Director's degree and their TX Medical Board #.
  4. Fill in the Personal DPS Number for the Medical Director.
  5. Next, enter the EMS Business Address of the current Medical Director. Include the street address, city, state, and zip code. Remember, a PO Box is not acceptable.
  6. Now move to the New Information (Medical Director) section. Repeat the same steps as above for the new Medical Director. Enter their name, degree, TX Medical Board #, and Personal DPS Number.
  7. Provide the EMS Business Address for the new Medical Director, ensuring it is not a PO Box.
  8. In the Drug Schedules section, check all applicable boxes for the drug schedules that apply to your registration. Options include Schedule II, II-Non-Narcotic, III, III-Non-Narcotic, IV, and V.
  9. Both the new Medical Director and the EMS Administrator must sign the form. Include their signatures, phone numbers, and the date of signing.
  10. Finally, review all the information for accuracy before submission. Make sure all signatures are present.

Once completed, send the form to the designated address or fax it as instructed. This ensures that your registration modification is processed smoothly.