Agency Schedule Detail

Authorization Number : 580-1254

Agency Series No. : PHA-24C

Status : Obsolete

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
Blank	Sue Slaughter	Records Officer	3/14/2008 10:53:00 AM
Blank	Michael Hardenbrook	Record Administrator	3/17/2008 9:49:00 AM
Blank	Martin Meeks	State Auditor	3/24/2008 2:57:00 PM
Blank	Fred Previts	State Archivist	4/7/2008 3:10:00 PM
Blank	Gregory Allison	Records Officer	8/26/2025 9:12:57 AM

Notes

Date	Reason	User
8/26/2025 9:12:57 AM	Abolishing DMH: creating new agency DBH	Gregory Allison