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.

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.