Report Lost or Stolen Prescription Pads

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

Select

Zip Code

Description of Incident*

Email Address

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

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