To obtain a profile request form, click on the appropriate field:

CONFIDENTIAL PROFILE REQUEST FOR PATIENTS

PRACTITIONER PROFILE REQUEST (Licensing Boards)

LAW ENFORCEMENT PROFILE REQUEST

CONFIDENTIAL THIRD-PARTY PATIENT PROFILE REQUEST

Practitioners and pharmacists may obtain copies of patient profiles for any patient for whom they are providing care or services. Requests for profiles must be submitted to the Board Office by facsimile or mail on a request form provided by the Board.

This service is offered during normal business hours, 8:00 am to 5:00 pm, Monday through Friday. This service is not available after hours, weekends, or holidays.

Upon receipt of a faxed or written request, a patient profile will be generated and faxed to the pharmacist or practitioner or, if requested, mailed. Patient profile requests received after 4:00 pm are subject to processing the next business day.

All practitioners and pharmacists must manually sign the request form. Signature stamps will not be accepted.