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Buprenorphine
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Pre-Filled Notification Form to Increase Patient Limit

If you submitted your original notification not less than one year ago, and your waiver has been certified, please enter the following three pieces of information:

To bring up a form pre-filled with the information we currently have on file for you, use the Get Form button below.

  • Get form.
  • Print the form using your browser's print command.
  • Please make any necessary corrections to the information on the form.
  • Sign and date the form.
  • Fax the form to 240-276-1630 or mail it to the address on the second page of the form, below the signature box.

 


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