Report Lost or Stolen Prescription Pads

Please use this form to report lost or stolen prescription pads

to the Maryland Board of Pharmacy.

Incident Date *

Date Reported to Board *

Prescriber's Name *

Prescriber's Specialty

Prescriber's Contact Information

Maryland County

Zip Code

Description of Incident *

Email Address

If you wish to receive a copy of your report, please enter your email address below.