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222 Form

Common 222 Form errors corresponding to numbers in the sample form below.

Use the correct sample below as a guide for filling out your form. 

  1. Supplier Name, Street Address, City, State, or Zip Code are not correct. Complete Supplier name as in example.
  2. The Name and Title field is incomplete.
  3. Form not signed.
  4. Form date not entered.
  5. Number of Packages not indicated. Complete as in example.
  6. Size of Package not indicated or extends into the item description field. Complete as in example.
  7. Incomplete Item Description; name/strength/form. Complete as in example.
  8. Last Line Completed not correct. Last Line indicates the last order line used on the form, as in the example. Roman numerals are not acceptable.
  9. Any alteration, erasure, overstrike, trace-over or change on the form will render the form unusable.
  10. Review the back of the form for official DEA guidelines. 

Note: 222 Form orders that cannot be filled due to product availability will be held up to 60 days from form date so order can be filled when product is available. Partial fills will require a new 222 form.