Form Doh 250 is a term you may have heard tossed around the office, but what exactly does it mean? It is an IRS form used to report the receipt of any foreign contribution or donation above $250.00. This form helps ensure that all donations are accounted for and reported in order to avoid any legal trouble. Any individual or organization receiving a donation over this amount must submit a Form Doh 250 within 15 days of receipt. So what do you do if you receive a foreign donation? Simply gather all the information pertaining to the donation and complete Form Doh 250. Not sure where to start? Check out our guide on How to Complete Form Doh 250 below!
Question | Answer |
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Form Name | Form Doh 250 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | Rx, deadiversion, Radiosotopic, New_York |
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NEW YORK STATE DEPARTMENT OF HEALTH |
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Official Prescription Program |
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BUREAU OF NARCOTIC ENFORCEMENT |
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Order Form |
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Complete items |
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PHYSICIAN’S SPECIALITY CODES |
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to a |
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Please identify the specialty that most closely describes your practice and enter the |
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To receive Official Prescriptions free of charge, you must be registered with the Official |
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order form in the space provided at left. If you are unable to identify your practice with one of the specialties listed, please |
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Prescription Program. |
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enter Code 600 and identify in writing the nature of your practice. |
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Forward Order Form to: Standard Register |
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Official Prescription Program |
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ALLERGY |
010 |
UROLOGY |
230 |
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631 Industrial Blvd. |
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ANESTHESIOLOGY |
020 |
EMERGENCY MEDICINE |
250 |
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P.O Box 1130 |
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COLON AND RECTAL SURGERY |
030 |
PATHOLOGY (Medical Microbiology) |
139 |
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Toccoa, GA 30577 |
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DERMATOLOGY |
040 |
PATHOLOGY (Neuropathology) |
141 |
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If you have questions, call |
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DERMATOPATHOLOGY |
041 |
PATHOLOGY (Pathologic Anatomy) |
142 |
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FAMILY PRACTICE |
050 |
PATHOLOGY (Dermalopathology) |
143 |
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- |
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MEDICINE |
060 |
PATHOLOGY (Anatomical & clinical) |
146 |
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1. |
NYS LICENSE NUMBER |
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MEDICINE (Cardiovasc. Disease) |
061 |
PATHOLOGY (Radiosotopic) |
148 |
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MEDICINE (Medical Oncology) |
062 |
PEDIATRICS |
150 |
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2. |
DRUG ENFORCEMENT ADMINISTRATION (DEA) NUMBER |
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MEDICINE (Endocrinology) |
063 |
PEDIATRIC CARDIOLOGY |
151 |
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MEDICINE (Gastroenterology) |
064 |
PEDIATRIC HEMATOLOGY ONCOLOGY |
152 |
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- |
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MEDICINE (Hematology) |
065 |
PEDIATRIC NEPHROLOGY |
153 |
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MEDICINE (Infectious Disease) |
066 |
NEONATAL – PERINATAL MEDICINE |
154 |
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MEDICINE (Nephrology) |
067 |
PEDIATRIC ENDOCRINOLOGY |
155 |
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DEA Registered Address - Prescriptions can only be printed and shipped to the address |
MEDICINE (Pulmonary Disease) |
068 |
PHYSICAL MEDICINE & REHABILITATION |
160 |
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MEDICINE (Rheumatology) |
069 |
PLASTIC SURGERY |
170 |
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printed on your Drug Enforcement Administration (DEA) Registration. |
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NEUROLOGICAL SURGERY |
070 |
PREVENTIVE MEDICINE (Aerospace) |
181 |
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If a practitioner does not have a DEA registration, prescriptions can only be printed and |
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NUCLEAR MEDICINE |
080 |
PREVENTIVE MEDICINE (General) |
182 |
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shipped to the address which is listed on a notarized registration form. |
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OBSTETRICS & GYNECOLOGY |
090 |
PREVENTIVE MEDICINE (Occupational) |
183 |
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OBSTETRICS & GYNECOLOGY |
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PREVENTIVE MEDICINE (Public Health) |
184 |
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Name_______________________________________________________________ |
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(Gynecologic Oncology) |
091 |
PSYCHIATRY & NEUROLOGY (Child Psych) |
191 |
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OBSTETRICS & GYNECOLOGY |
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PSYCHIATRY & NEUROLOGY (Psychiatry) |
192 |
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DEA Registered Address:_______________________________________________ |
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(Maternal - Fetal Medicine) |
092 |
PSYCHIATRY & NEUROLOGY (Neurology with |
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OBSTETRICS & GYNECOLOGY |
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Special Competence in Child Neurology) |
193 |
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_______________________________________________ |
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(Reproductive Endocrinology) |
093 |
PSYCHIATRY & NEUROLOGY (Neurology) |
194 |
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OPHTHALMOLOGY |
100 |
PSYCHIATRY & NEUROLOGY |
195 |
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ORTHOPEDIC SURGERY |
110 |
PSYCHIATRY & NEUROLOGY (Unspecified) |
196 |
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_______________________________________________ |
OTOLARYNGOLOGY |
120 |
RADIOLOGY – ALL |
200 |
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PATHOLOGY (Unspecified) |
130 |
RADIOLOGY (Diagnostic) |
201 |
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Phone Number ( |
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)- |
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PATHOLOGY (Blood Banking) |
131 |
RADIOLOGY (Diagnostic with Special |
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PATHOLOGY (Clinical Pathology) |
135 |
Competence in Nuclear Radiology) |
202 |
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PATHOLOGY (Forensic Pathology) |
136 |
RADIOLOGY (Therapeutic) |
203 |
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3. |
NUMBER OF BOOKS |
1 |
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5 |
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10 |
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15 |
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20 |
PATHOLOGY (Hematology) |
137 |
RADIOLOGY (Radiological Physics – All) |
204 |
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PATHOLOGY (Chem. Pathology) |
138 |
RADIOLOGY (Therapeutic Radiological Physics) |
205 |
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(20 Book Max) |
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(100 Rx) |
(500 Rx) |
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(1000 Rx) |
(1500 Rx) |
(2000 Rx) |
RADIOLOGY (Radiological Physics Unspecified) |
209 |
RADIOLOGY (Diagnostic Radiological Physics) |
206 |
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SURGERY |
210 |
RADIOLOGY (Medical Nuclear Physics) |
207 |
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SURGERY (Pediatric) |
211 |
RADIOLOGY (Unspecified) |
208 |
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4. |
SPECIALTY CODE (Physician’s Only) |
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_____________________________ |
THORACIC SURGERY |
220 |
OTHER (Please specify on form) |
600 |
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By my signature, I certify that I am registered with the DEA (if applicable) and that a current |
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order of the Commissioner of Health revoking or canceling use of such forms has not been |
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served to me. |
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5. |
SIGNATURE_________________________________________ 6. DATE ____/____/____ |
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******ATTENTION****** |
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PHYSICIAN’S ASSISTANTS: |
SUPERVISING M.D. INFORMATION (P.A. only) |
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CHANGE OF ADDRESS |
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ORDERS MUST ALSO CONTAIN THE FOLLOWING |
NAME________________________________________ |
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Do not send this order until you have a new registration certificate from the DEA. |
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INFORMATION OF THE SUPERVISING M.D.: |
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NAME |
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DEA |
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LICENSE______________________________________ |
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• |
LICENSE NUMBER |
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Attn: Registration Unit |
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• |
DEA NUMBER |
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99 10TH Avenue |
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DEA__________________________________________ |
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ORDERS NOT CONTAINING THIS |
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New York, NY 10011 |
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INFORMATION WILL NOT BE PROCESSED. |
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(Contact DEA at |
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Return new DEA certificate along with your Order Form and we will process your official |
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prescription order. |
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