Practitioner Procedures for Requesting Access
The PDMP database is an electronic tool developed to provide Practitioners with a source of information regarding the controlled substance usage of a patient.
To request access to the PDMP Database a Practitioner must:
Follow the instructions for completing the Prescriber / Dispenser Database Access Request Form.
Complete the Prescriber / Dispenser Access Request form and Privacy Statement form.
- Create a password and place password in the designated area on the Access Request Form
Passwords must be at least 8 characters in length.
Passwords must not contain dictionary words or a name.
Passwords must contain at least one (1) capital letter, (1) lowercase
letter, and (1) number. For example:
H82bYb – would be acceptable
Bob 123 – would not be acceptable
Rover9 – would not be acceptable
- Print the Prescriber/Dispenser Access Request Form and Privacy Statement Form
- Sign and date both forms
- Have Prescriber/Dispenser Access Request Form notarized
- Make a copy of your AZ Board License, DEA Registration, and current Driver’s License
- Retain a copy of all forms for your records
(Note: If the Access Request Form is filled in by hand, block print must be used to increase legibility.)
Mail the following items to the Controlled Substances Prescription Monitoring Program:
- Notarized Prescriber/Dispenser Access Request Form
(Note: ASBP will not process a faxed Access Request Form)
- Signed copy of the Privacy Statement Form
- Copies of current AZ Board License, DEA Registration, and Driver’s License
Arizona State Board of Pharmacy
Controlled Substances Prescription Monitoring Program
1700 W. Washington Street, Suite 250
Phoenix, Arizona 85007-2835
(602) 771-2744
Once the Access Request documents are received and approved, the requestor will receive an e-mail from our 15-minute online training course at careermap.net. Once the requestor has completed the online training course, ASBP's technical expert (Health Information Designs) will notify the requestor via two separate e-mails. The first e-mail will contain a CSPMP system Login User Name and the Database Web Link. The second e-mail will contain a PIN number and an 800 help desk phone number.
Note: ASBP will not process a faxed Access Request Form. Supporting documents can be sent via fax or e-mail (dwright@azpharmacy.gov) however, CSPMP staff recommends that all documents be sent via mail. If you choose to send your supporting documents via fax or e-mail, please make sure all documents are legible.
