PDMP Forms

​Prescriber Data Request

​CRISP has available for Maryland prescribers who have a valid DEA number, a DEA Self-Audit report within its Unified Landing Page (ULP): https://ulp.crisphealth.org/​. This report displays the individual prescriber’s CDS prescriptions across all patients, allowing opportunity to view and understand prescribing trends. It can also be used as a tool to audit for potential fraud concerns, for example if a prescription pad goes missing.

The report can only be run by a prescriber to see his own history. This feature currently supports one DEA number per user. Anyone who possesses multiple DEA numbers, for example a separate DEA for suboxone prescribing, can run the report only for the DEA they registered with on their ULP account. The ability to report on more than one DEA number is a future enhancement in CRISP. For a report of prescriptions attributed to additional DEA numbers, please submit the above Maryland Prescription Drug Monitoring Program (PDMP) Prescriber Data Request Form to the PDMP office.​

Patient Data Request

For a report of prescriptions dispensed to a patient, please submit the below Maryland Prescription Drug Monitoring Program (PDMP) Patient Data Request form to the PDMP office.

Dispenser Exemption Attestation from Reporting to the PDMP

Pharmacies and practitioners that meet the definition of “dispenser” are required to register with the Program. However, dispensers that are not exempt from the reporting requirement but do not stock or dispense CDS prescription drugs may submit an attestation to the fact and receive a waiver from the registration requirement.  Please click HERE​​ to electronically submit a Maryland PDMP Exemption Attestation Form for a pharmacy, dispenser practitioner, or a hospice waiver. 

Dispenser Reporting Deadline Waiver for 24 Hour and/or Zero Reporting​

At the Maryland Department of Health Secretary’s discretion, a dispenser may be granted a waiver from the requirement to report data to the Maryland PDMP every 24 hours, including zero reports. The reason for a reporting deadline waiver must be 'particular to a unique problem, incident or other issue that prevents the dispenser from meeting the reporting deadline.”  

Please describe in detail the reason for the dispenser’s request to receive a waiver from daily reporting, including zero reporting, and include any available documentation of the specific circumstances that prevent the dispenser from meeting the reporting deadline.  Please click HERE to download the form and email the completed form to mdh.pdmp@maryland.gov​​