Certain Entity – Required Reporting of Unassigned Administered Epinephrine to DSHS
Certain entities that voluntarily adopt an unassigned epinephrine policy must report the administration of unassigned epinephrine. This requirement is in the 25 Texas Administrative Code, Section 40.17.
No later than the 10th business day after the date unassigned epinephrine is administered, your entity must submit a report in accordance with the 25 Texas Administrative Code, Sections 40.17. The report must be submitted to the:
- Prescribing physician and
- Commissioner of the Department of State Health Services (DSHS).
Submission of this electronic form meets the reporting requirement for DSHS. Be sure to report complete and accurate information.
Please fill out the entire form and provide detailed information.
All fields with an asterisk (*) must be completed.