Please print the appropriate form and fill in each section as completely as possible. Please either email the completed form to firstname.lastname@example.org; or fax the form to 1-877-862-4252. Attach copies of the prescription, photographs, or any related documents that may assist the investigation. Both forms may be used at any time by either the practitioner or the pharmacist to inform PCD and provide more detailed information. Remember to contact the Metropolitan Police Department to file a formal complaint.
PCD101 Forged or Stolen Prescription Report Form. This form is used primarily by the practitioner to inform PCD.
PCD102 Fraudulent Prescription Identification Form. This form is used primarily by the pharmacy to identify the person who presented the prescription.