EPCS LICENSE KEY NUMBER REGISTRATION
EPCS LICENSE KEY NUMBER SOFTWARE
EPCS LICENSE KEY NUMBER LICENSE NUMBER

Am I required to register each certified EPCS software application that I use?

I work at more than one location and each location uses a different software application. Identity proofing must be completed and the practitioner must obtain two-factor authentication prior to registering the certified EPCS software application with BNE. Can I register my certified EPCS software application before I've completed the identity proofing and obtained two-factor authentication? The certified EPCS software application must be registered with BNE at least every two years from the date of DEA certification or third party audit or whenever functionality related to controlled substance prescription requirements is altered, whichever occurs first. How often do I have to register my certified EPCS software application with BNE? Print Name: The practitioner's name should be printed in this field.Date: Date that the form was signed by the practitioner.Practitioner Signature: Signature of the practitioner.Name of Software Application Provider (Company Name): Name of the company (or corporation if you are not using a vendor) providing the certified EPCS software application.If you are not sure what version you are currently using, contact your software application vendor. Software Version Certified: Version number of the EPCS application.If you are not sure what the name of your software application is, contact your software application vendor. Name of Certified E-prescribing Software Application: Name of the application you are using to electronically prescribe controlled substances.Practitioner Telephone Number: Phone number of the practitioner.

Practitioner Email Address: Enter the practitioner's Email address.

DEA Number for NYS: Enter each New York State DEA number that will be utilized to electronically prescribe controlled substances.

EPCS LICENSE KEY NUMBER LICENSE NUMBER

NYS License Number: Enter your New York State license number.

EPCS LICENSE KEY NUMBER REGISTRATION

If you are a Physician's Assistant, please attach a list of your Supervising Physician(s) with their corresponding NYS license number and DEA registration number.

Practitioner Name: Enter your first and last name in this field.

Below is a summary of each field and the information to be entered. How do I fill out the registration form?Ĭomplete all fields on the form. Instructions for Practitioner EPCS Registration Form Why do I need to register with the Bureau of Narcotic Enforcement (BNE)? My software vendor already notified BNE.Įach individual practitioner, not the software vendor, is required by regulation to register their certified EPCS software application with BNE.

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Epcs license key number