These standards describe the format for transmission of data regarding distribution of controlled substance samples by manufacturers or distributors to licensed practitioners in the state of Washington.

(1) Each report shall contain the following information regarding the firm distributing controlled substance samples:

(a) Name of firm.

(b) DEA number of firm.

(c) Complete address of firm including zip code.

(d) Name and phone number of contact person.

(2) Each report shall contain the following information regarding the licensed practitioner to whom samples are distributed:

(a) First and last name of practitioner.

(b) DEA number of practitioner.

(c) Professional designation of practitioner. (E.g., MD, DO, DDS.)

(d) Complete address of practitioner including zip code.

(3) Each report shall contain the following information regarding the controlled substance(s) distributed:

(a) Name of controlled substance(s) distributed.

(b) Dosage units of controlled substance(s) distributed.

(c) Quantity distributed.

(d) Date distributed.

(4) Each report shall be submitted in alphabetical order by practitioner's last name.

(5) Each report shall be submitted quarterly.