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SELF-INSPECTION FORMS
Pharmacist-In-Charge Forms
Must be completed by February 1 annually
 
Oregon law requires each pharmacist-in-charge (PIC) to conduct an annual self-inspection of their pharmacy and to document the inspection by completing a self-inspection report by February 1st of each year. This form needs to be completed and available for inspection by the Board at all times.  The purpose of the self-inspection is to ensure the pharmacy is in compliance with all state and federal laws and rules governing the practice of pharmacy. Newly assigned PIC's are required to complete a self-inspection of their pharmacy within 15 days of becoming the PIC.  
 
These forms are available below for downloading. Once completed, self-inspection reports must be retained in the pharmacy and be readily retrievable by a Board Inspector. 
 

2018 Resident Retail Pharmacy I​nspection Form​​​

2018 Non-Resident Pharmacy Inspection Form

2018 Hospital Pharmacy Inspection Form

2018 Long Term Care Pharmacy Inspection Form 

2018 Home Infusion Pharmacy Self Inspection Form

2018 Nuclear Pharmacy Self Inspection Form

2018 Compounding Pharmacy Self Inspection Form 

 

Medical Director or Clinic Representative for

Community Health Clinics & Dispensing Practitioner Drug Outlets

An Oregon public healthcare facility that utilizes a Registered Nurse to dispense medications requires registration with the Oregon Board of Pharmacy as a Community Health Clinic (CHC).
 
Oregon Administrative Rule 855-043-0710 states that a Community Health Clinic Drug Outlet must employ a Medical Director who is an Oregon practitioner with prescriptive and dispensing authority. The CHC must designate a representative employee who will be the contact person for the Oregon Board of Pharmacy and must be onsite the majority of the CHC’s normal operating hours.
 
The Medical Director or the designated representative must conduct and document an annual review of the outlet. The completed report form must be filed in the clinic, and be available to the Board for inspection for three years.
 
The form is available below for downloading. Once completed, the self-inspection report must be retained in the clinicand be readily retrievable by a Board Inspector. 
 
2018 Community Health Clinic Inspection Form
 
 
practitioner’s facility that engages in dispensing certain FDA-approved human prescription drug therapies greater than a 72 hours supply or any medication refill must register their dispensing site as a drug outlet with the Board as a Dispensing Practitioner Drug Outlet (DPDO). 

The Medical Director or the Clinic Representative must conduct and document an annual review of the outlet. The completed report form must be filed in the clinic, and be available to the Board for inspection for three years.
 
The form is available below for downloading. Once completed, the self-inspection report must be retained in the clinicand be readily retrievable by a Board Inspector. 
 
Consultant Pharmacist

Oregon law requires each Consultant Pharmacist to conduct an annual self-inspection of their pharmacy and to document the inspection by completing a self-inspection report by February 1st of each year. This form needs to be completed and available for inspection by the Board at all times.  The purpose of the self-inspection is to ensure the pharmacy is in compliance with all state and federal laws and rules governing the practice of pharmacy. Although not required by law, it is recommended that newly assigned Consultant Pharmacists complete a self-inspection of their pharmacy within ten days of becoming the Consultant Pharmacist. 

 
These forms are available below for downloading. Once completed, self-inspection reports must be retained in the pharmacy and be readily retrievable by a Board Inspector. 
 
 
 

2018 Correctional Facility Inspection Form 

2018 Home Dialysis Inspection Form

Wholesaler Forms
Must be completed by September 1, 2018

Oregon law requires each Wholesale Facility to conduct an annual self-inspection of their establishment and document the inspection by completing a self-inspection report by September 1st of each year. This form needs to be completed and available for inspection by the Board at all times.  The purpose of the self-inspection is to ensure the facility is in compliance with all state and federal laws and rules governing the practice of pharmacy. 

This form is available below for downloading. Once completed, self-inspection reports must be retained at the facility and be readily retrievable.

2018 Wholesaler Self Inspection Form

 

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