Agency Schedule Detail

Authorization Number : 51130005

Agency Series No. : 1590028

Status : Active

Agency Web Link :

Agency : DBH

Confidential Description :

Division : DBHCOFF

Vital Description :

Section : DBHCOFFPHAR

Record Title : Refill Request

Revision : 0

Record Description : 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.		Electronic	Delete
Retain 1 year after receipt, then destroy.		Paper	Shred

Approvals

Status	Name	Title	Date
Approved	Gregory Allison	Records Officer	11/21/2025 2:28:25 PM
Approved	Terri Dittmar	Record Administrator	11/24/2025 7:53:27 AM
Approved	Martin Meeks	State Auditor	11/26/2025 9:33:28 AM
Approved	Fred Previts	State Archivist	11/28/2025 4:44:40 PM

Notes

Date	Reason	User