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Donated Medication Forms

Unused Medication Program Forms

The Utilization of Unused Medications Program is outlined in K.A.R. 68-18-1 through 68-18-3. Donating and accepting entities wishing to participate in the program should review these regulations prior to completing the forms below.

N-400 Participation Form-Donating Entity
N-450 Participation Form-Clinics & Qualifying Centers (clinics and qualifying centers only - You must be registered with the Board to receive medications - See the BA-11 Health Department or Clinic form for registration details)

Instructions for Utilization of Unused Medication Program

Adult Care Home- Unused Medications Manifest and Declaration

Mail Order Pharmacy & Medical Care Facility- Unused Medications
Manifest and Declaration

Unused Medications Manifest

Statutes & Regulations

K.A.R. Article 18. Utilization of Unused Medications
65-1668. Utilization of unused medications act; not applicable to certain medications.
65-1669. Same; definitions.
65-1670. Same; duties of the board of pharmacy; duties of qualifying center or clinic.
65-1671. Same; criteria for accepting unused medications; dispensing.
65-1672. Same; participation; adult care homes; powers and duties of qualifying center or clinic.
65-1673. Same; criminal and civil liability under the act.
65-1674. Same; rules and regulations; duties of the board of pharmacy.
65-1675. Same; duties of the secretary of health and environment; records.