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Content Overview

The Texas Nar 115 form plays a crucial role in the modification of registration for Emergency Medical Services (EMS) under the Texas Controlled Substances Act. This form is essential for ensuring that EMS providers maintain compliance with state regulations regarding the handling and administration of controlled substances. It requires detailed information about both the old and new medical directors, including names, degrees, Texas Medical Board numbers, and personal DPS numbers. Additionally, the form captures the EMS business address, which must be a physical location, as PO Box addresses are not accepted. Another significant aspect of the Nar 115 is the section dedicated to drug schedules, where the medical director must indicate which schedules apply to their practice. This includes a range of controlled substances from Schedule II to Schedule V. The form also includes a section for signatures from both the medical director and the EMS administrator, certifying that the information provided is accurate and current. By signing, applicants grant permission for inspections of controlled premises or records as mandated by the Texas Controlled Substances Act of 1973. This process not only helps maintain regulatory compliance but also ensures the safety and well-being of the communities served by EMS providers.

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Modification of Registration-EMS
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 II-Non-Narcotic
(3) Schedule III
(3N) Schedule III-Non-Narcotic
(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 MSC-0438, PO Box 4087, Austin, Texas, 78773-0438
Or fax to 512/424-5799
NAR-115 (5/10)
➤ PDF File

Form Specifications

Fact Name Description
Governing Law The Texas Nar 115 form is governed by the Texas Controlled Substances Act.
Purpose This form is used to modify the registration of Emergency Medical Services (EMS) under the Texas Controlled Substances Act.
Medical Director Information The form requires both old and new information for the Medical Director, including name, degree, and Texas Medical Board number.
EMS Business Address The EMS business address must be provided, and a P.O. Box is not acceptable.
Drug Schedules Applicants must check all applicable drug schedules, including Schedule II through Schedule V.
Signatures Required Signatures from both the Medical Director and EMS Administrator are required on the form.
Submission Method The completed form can be mailed or faxed to the specified address in Austin, Texas.
Certification Notice Applicants certify that the information provided is accurate and grant inspection rights to the director or designee.

Texas Nar 115: Usage Guidelines

Filling out the Texas Nar 115 form is an important step in updating your EMS registration information. Make sure you have all the necessary details ready before you begin. This will help ensure that the process goes smoothly.

  1. Start by entering the EMS Registration Information at the top of the form. Fill in your DPS Number, DEA Number, and DSHS Board License Number.
  2. Next, provide the Old Information for the Medical Director. Write the name (Last, First, Middle), degree, TX Medical Board number, and personal DPS number.
  3. Fill in the EMS Business Address for the old Medical Director. Include the street address, city, state, and zip code. Remember, a PO Box cannot be accepted.
  4. Now, move on to the New Information section for the Medical Director. Again, enter the name (Last, First, Middle), degree, TX Medical Board number, and personal DPS number.
  5. Provide the EMS Business Address for the new Medical Director, ensuring it is a physical address, not a PO Box. Include the street address, city, state, and zip code.
  6. In the Drug Schedules section, check all applicable boxes for the schedules that apply to your registration. Options include Schedule II, Schedule II-Non-Narcotic, Schedule III, Schedule III-Non-Narcotic, Schedule IV, and Schedule V.
  7. Have the Medical Director sign and date the form. Include their phone number next to their signature.
  8. Finally, the EMS Administrator must also sign and date the form, providing their phone number as well.

Once the form is completed, it should be sent to the appropriate address or faxed as indicated at the bottom of the form. Make sure to keep a copy for your records.

Your Questions, Answered

What is the Texas Nar 115 form used for?

The Texas Nar 115 form is utilized for the modification of registration under the Texas Controlled Substances Act. This form is specifically designed for Emergency Medical Services (EMS) providers to update or change information related to their EMS registration. Common modifications include changes to the Medical Director's information, business address, and drug schedules that the EMS is authorized to handle.

Who needs to complete the Texas Nar 115 form?

The form must be completed by EMS providers who need to update their registration details with the Texas Department of Public Safety (DPS) and the Texas Department of State Health Services (DSHS). This includes any changes in the Medical Director's name, qualifications, or contact information, as well as updates to the EMS business address and the drug schedules the service is authorized to manage.

What information is required on the Texas Nar 115 form?

The Texas Nar 115 form requires several key pieces of information. This includes the old and new Medical Director's name, degree, Texas Medical Board number, personal DPS number, and the EMS business address. Additionally, EMS providers must indicate which drug schedules they will be handling by checking the appropriate boxes. Signatures from both the Medical Director and the EMS Administrator are also necessary to validate the information provided.

Where should the completed Texas Nar 115 form be submitted?

Once the Texas Nar 115 form is completed, it should be returned to the Controlled Substances Registration office. This can be done by mailing the form to MSC-0438, PO Box 4087, Austin, Texas, 78773-0438. Alternatively, the form can be faxed to 512-424-5799. It is essential to ensure that the information is accurate before submission to avoid any delays in processing.

What happens if the information on the Texas Nar 115 form is incorrect?

Submitting incorrect information on the Texas Nar 115 form can lead to delays in the modification process or potential denial of the registration update. The signature of the applicant certifies that the information provided is current and correct. If discrepancies are found after submission, the EMS provider may be required to resubmit the form with the correct details, which can impact their ability to operate legally under the Texas Controlled Substances Act.

Common mistakes

  1. Failing to provide complete personal information. Applicants often overlook the necessity of including all relevant details such as the DPS Number, DEA Number, and DSHS Board License Number. Incomplete information can lead to delays in processing.

  2. Not updating the Medical Director's information. When there is a change in the Medical Director, it is crucial to fill out the new information section accurately. Neglecting this can result in compliance issues.

  3. Using a PO Box for the EMS Business Address. The form specifically states that a PO Box is not acceptable. Providing a physical address is mandatory for proper registration.

  4. Incorrectly checking the Drug Schedules. Applicants must ensure they select all applicable schedules. Misunderstanding which schedules apply can lead to legal complications and potential penalties.

  5. Omitting necessary signatures. Both the Medical Director and EMS Administrator must sign the form. Without these signatures, the application will not be processed.

Documents used along the form

The Texas Nar 115 form is essential for modifying registration under the Texas Controlled Substances Act, particularly for Emergency Medical Services (EMS). However, several other forms and documents are often used in conjunction with this form to ensure compliance and proper documentation. Below is a list of some of these important documents.

  • Texas Controlled Substances Registration Application: This form is used by medical professionals and facilities to apply for a registration that allows them to handle controlled substances. It provides necessary information about the applicant, including their credentials and the type of substances they intend to use.
  • Medical Director Agreement: This document outlines the relationship and responsibilities between the EMS provider and the medical director. It clarifies the scope of medical oversight and ensures that the medical director's qualifications align with Texas regulations.
  • Controlled Substances Inventory Form: This form is crucial for documenting the quantities and types of controlled substances on hand. Regular inventory checks help maintain compliance with state and federal regulations, ensuring that all substances are accounted for and properly managed.
  • Emergency Medical Services (EMS) Protocols: These are standard operating procedures that guide EMS personnel in the administration of medications, including controlled substances. Protocols ensure that all actions taken by EMS staff are within the legal framework and align with best practices in patient care.

Utilizing these forms in conjunction with the Texas Nar 115 can help ensure that EMS providers operate within the legal parameters set by the state. Keeping accurate and up-to-date records is not only a regulatory requirement but also vital for the safety and effectiveness of emergency medical services.

Similar forms

The Texas Nar 115 form is an important document used for the modification of registration under the Texas Controlled Substances Act. Several other documents serve similar purposes in various contexts. Here are five documents that share similarities with the Texas Nar 115 form:

  • Texas Controlled Substance Registration Application: This document is used to apply for initial registration to handle controlled substances. Like the Nar 115, it requires detailed information about the applicant and the business address.
  • DEA Form 224: This form is used to register with the Drug Enforcement Administration (DEA) to dispense controlled substances. Both forms require identification numbers and business addresses, ensuring compliance with state and federal laws.
  • Texas Medical Board License Renewal Application: This application is necessary for renewing a medical professional's license in Texas. Similar to the Nar 115, it includes personal information and requires signatures to confirm accuracy.
  • Controlled Substances Inventory Form: This document is used to report the inventory of controlled substances held by a facility. Both forms emphasize the importance of accurate record-keeping and compliance with regulations.
  • Texas EMS Provider License Application: This application is for obtaining a license to operate as an EMS provider. Like the Nar 115, it requires detailed information about the organization and its leadership, highlighting the importance of oversight in emergency medical services.

Dos and Don'ts

When filling out the Texas Nar 115 form, it is crucial to approach the process with care and attention to detail. Here are four essential do's and don'ts to keep in mind:

  • Do ensure accuracy: Double-check all information before submission. Errors can lead to delays or complications.
  • Do provide complete information: Fill in all required fields, including your DPS number and DEA number, to avoid any issues with your application.
  • Do use a physical address: Make sure to provide a valid EMS business address. PO Box numbers are not acceptable.
  • Do sign and date the form: Your signature certifies that the information is correct and allows for necessary inspections.
  • Don't rush the process: Take your time to review the form thoroughly. Incomplete or rushed submissions can result in rejection.
  • Don't ignore the instructions: Follow all guidelines provided in the form to ensure compliance with the Texas Controlled Substances Act.
  • Don't submit without a copy: Always keep a copy of the completed form for your records. This can be important for future reference.
  • Don't forget to check deadlines: Be aware of any submission deadlines to avoid delays in your registration process.

By adhering to these guidelines, you can help ensure a smoother experience when filling out the Texas Nar 115 form.

Misconceptions

Here are six common misconceptions about the Texas NAR 115 form:

  • The NAR 115 form is only for new EMS registrations. Many believe this form is only for initial registrations. In reality, it is used for modifications to existing registrations as well.
  • You can use a PO Box for the EMS business address. Some people think a PO Box is acceptable. However, the form explicitly states that only a physical address is permitted.
  • All medical directors must have a DEA number. While a DEA number is often required, it is not mandatory for all medical directors. It depends on their specific role and responsibilities.
  • Only the medical director needs to sign the form. This is incorrect. Both the medical director and the EMS administrator must sign the form for it to be valid.
  • Submitting the form is the only requirement for compliance. Many assume that submitting the NAR 115 form is sufficient for compliance. In truth, ongoing compliance with the Texas Controlled Substances Act is necessary.
  • The form does not require a phone number. Some individuals overlook the phone number section. Providing a phone number is essential for communication regarding the registration.

Key takeaways

When filling out and using the Texas Nar 115 form, keep the following key takeaways in mind:

  • Accurate Information is Crucial: Ensure that all details, including names, addresses, and license numbers, are filled out accurately. Any discrepancies can lead to delays in processing.
  • Signature Requirements: Both the Medical Director and the EMS Administrator must sign the form. Their signatures confirm that the information provided is correct and that they authorize inspections as required by law.
  • Drug Schedules: Carefully check all applicable drug schedules. This section is vital as it determines the scope of the EMS’s ability to handle controlled substances.
  • Business Address Restrictions: The EMS business address cannot be a P.O. Box. A physical address is required for compliance with the Texas Controlled Substances Act.
  • Submission Methods: After completing the form, you can submit it either by mail or fax. Make sure to send it to the correct address to avoid any processing issues.