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How do I fill this out?
To fill out this form, you can type information directly into the online version or print it and fill it out by hand. Make sure to complete all sections thoroughly. After filling out the form, remember to sign and date it before submission.
How to fill out the Change in Pharmacist Contact Information Form?
1
Type or handwrite the required information on the form.
2
Complete all sections without leaving any blank.
3
Sign and date the form at the designated areas.
4
Submit the form via mail or email as instructed.
5
Retain a copy of the form for your pharmacy's records.
Who needs the Change in Pharmacist Contact Information Form?
1
Pharmacists needing to update their contact details.
2
Pharmacy owners changing their business address.
3
Clinical research site coordinators managing pharmacy operations.
4
Project Managers who rely on accurate pharmacy information.
5
Administrative staff tasked with record keeping and compliance.
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What are the instructions for submitting this form?
To submit this form, complete all sections and send it to the DAIT Project Manager via email or physical mail. For email submission, please refer to the specific email address located in the study-specific manual of procedures. For physical submission, send it to the Division of Allergy, Immunology, and Transplantation at 5601 Fishers Lane, Room 7D30, Bethesda, MD 20892.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting this form include the initial notification of changes and follow-up reminders every quarter in 2024 and 2025. Ensure to keep track of any deadlines set by your Project Manager, as late submissions may lead to compliance issues. Always check your local regulations for specific requirements.
What is the purpose of this form?
The purpose of this form is to formally notify relevant stakeholders about changes in pharmacy contact information and address details. It serves to keep records updated to ensure compliance with regulations and facilitate efficient communication. Failure to submit this form timely may lead to operational disruptions.
Tell me about this form and its components and fields line-by-line.
- 1. Clinical Research Site Name: The name of the clinical research site associated with the pharmacy.
- 2. Pharmacy Phone Number: The current phone number of the pharmacy.
- 3. New Pharmacy Phone Number: The new phone number to be updated.
- 4. Pharmacist Name: Name of the pharmacist in charge.
- 5. Email Address: The email address of the pharmacist.
- 6. New Mailing Address: The updated mailing address for the pharmacy.
- 7. Signature of Pharmacist: Signature field for the pharmacist completing the form.
What happens if I fail to submit this form?
Failure to submit this form can lead to outdated contact information, which may hinder communication between the pharmacy and the Project Manager. This could result in compliance problems and operational disruptions.
- Outdated Information: Incorrect contact details can lead to failed communications.
- Compliance Issues: Timely updates are essential for regulatory adherence.
- Operational Disruptions: Delays in processing changes can affect pharmacy operations.
How do I know when to use this form?
- 1. Change in Phone Number: Use the form to notify changes to the pharmacy phone number.
- 2. Change in Fax Number: Notify any updates to the pharmacy's fax number.
- 3. Change in Email Address: Update the email address used for pharmacy communications.
Frequently Asked Questions
What information do I need to fill out the form?
You will need the pharmacy's current contact details, the name of the pharmacist, and the new information you wish to submit.
Can I edit this PDF online?
Yes, you can edit the PDF directly in PrintFriendly's online editor, making it easy to customize.
How do I submit the form?
You can submit the form via mail or email to the designated Project Manager.
Is there a deadline for submission?
It's important to submit the form promptly to avoid any potential disruptions in service.
What if I make a mistake on the form?
You can edit the form in the PrintFriendly editor before submission or make corrections by hand if printed.
Can I save my changes?
Yes, download the edited document and save it as needed.
What should I do with the original form?
Keep the original form filed securely in your pharmacy binder.
How do I contact the Project Manager?
You can find the Project Manager's contact details in the study-specific manual of procedures.
Is support available if I have questions?
Yes, PrintFriendly offers support for any inquiries regarding form usage.
Can I send the form via fax?
Yes, you can fax the completed form to the pharmacy's designated fax number.
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