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Agency Schedule Detail

Authorization Number :  580-1254
Agency Series No. :  PHA-24C
Status :  Active
Agency Web Link : 
Agency :  DMH
Confidential Description :   
Division :  DMHCOff
Vital Description : 
Section :  DMHCOff
Record Title :  Refill Request
Revision :  1
Record Description :  (DMH-0444) Form generated by the mental health clinics and sent to Central Pharmacy listing the medications on which refills are requested. Includes facility name, client no., client name, Rx no., medication to be refilled, authorizing signature, etc.
Retention Period Retention Justification Media Code Method of Disposal
Retain 1 year after receipt, then destroy. Paper Shred

Approvals

Status Name Title Date
Approved Sue Slaughter Records Officer 3/14/2008 10:53:00 AM
Approved Michael Hardenbrook Record Administrator 3/17/2008 9:49:00 AM
Approved Martin Meeks State Auditor 3/24/2008 2:57:00 PM
Approved Fred Previts State Archivist 4/7/2008 3:10:00 PM

Notes

Date Reason User

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