In the realms of healthcare and legal oversight, forms and documents play pivotal roles, weaving through the fabric of regulation and compliance to ensure that entities operate within the boundaries of law and ethics. Among such documents, the Texas NAR 115 form serves as a crucial piece in the framework of healthcare services, particularly concerning entities that handle controlled substances. This document, officially titled "Modification of Registration-EMS under Texas Controlled Substances Act," serves a dual function. On the one hand, it acts as a vessel for emergency medical services (EMS) to update crucial information regarding their medical directors, a necessity for maintaining transparency and accountability in the handling and administration of controlled substances. On the other, it plays an instrumental role in monitoring and ensuring compliance with the Texas Controlled Substances Act of 1973, a cornerstone in the state's efforts to regulate drugs and their potential misuse. By diligently filing this form, complete with updates on medical directors' information, EMS registration information including DPS and DEA numbers, and the specific drug schedules their operations encompass, organizations affirm their commitment to lawful conduct and the safeguarding of public health. Additionally, through the act of signing this document, the applicants not only verify the accuracy and currentness of the information provided but also consent to inspections, thereby underscoring the reciprocal relationship between regulatory bodies and healthcare entities. This form, with its comprehensive scope and implications, embodies the intricate balance between regulatory oversight and the operational autonomy of healthcare providers, marking a significant point of interaction in the broader healthcare regulatory landscape of Texas.
| Question | Answer |
|---|---|
| Form Name | Texas Form Nar 115 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | designee, Admin, certifies, EMS |
Modification of
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
(3) Schedule III
(3N) Schedule
(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