CDS Forms & Applications
Practitioners
This category includes licensed health care practitioners with prescriptive authority for controlled substances, including physicians [MD] (including those with telemedicine licenses [MDT]), podiatrists [DPM], dentists [DDS], optometrists [OD], advanced practice registered nurses [APRN], physician assistants [PA-C], medical psychologists [MP], and veterinarians [DVM].
101 Application for New CDS License for Practitioner (revised 08-01-2017)
102 Application for Renewal of CDS License for Practitioner
Facilities
This category includes manufacturers, distributors, hospitals, substance abuse clinics, and registered outsourcing facilities. It does not include pharmacies.
105 Application for New CDS License for Facility (revised 05-15-2016)
106 Application for Renewal of CDS License for Facility
107 Notice of Permanent Closure of CDS License at Facility
Selected Persons & Organizations
This category includes researchers, medical sales representatives, drug detection canine handlers, animal euthanasia technicians, as well as laboratories.
110 Application for New CDS License for Selected Persons & Organizations
111 Application for Renewal of CDS License for Selected Persons & Organizations
Pharmacies
This category includes pharmacies located within the state and licensed by the Board.
115 Application for New CDS License for Pharmacy
116 Application for Renewal of CDS License for Pharmacy for 2016
116-L Application for Late Renewal of CDS License for Pharmacy for 2016
117 Application for New CDS License for Automated Medication System (AMS)
118 Application for Renewal of CDS License for AMS (or AMX) for 2016-2017
118-L Application for Late Renewal of CDS License for AMS (or AMX) for 2016-2017
For General Use
120 Notice of Change of Address for CDS License
201 Product Order Form - Duplicate Credential
Please Note: If your CDS license has been expired for more than 30 days, it is too late to renew it. However, you can apply for the reinstatement of the license. To do so, please mail a renewal form to the Board office with the appropriate late fee, and further, if the license has been lapsed for more than one year, please include a brief written explanation for the lapse. The licensing staff will review your application and advise you if any further information will be required. Finally, all CDS licenses expire one year after their initial issuance, and that initial renewal date is maintained for the life of the license. If your proposed reinstatement date is close to the annual renewal date, the staff will ask for confirmation of your intent to renew your license for less than a full year.
