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NY DOH-2340 2019-2024 free printable template

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Request for Approval of Disposal/Destruction of Controlled Substances YORK STATE DEPARTMENT OF HEALTH Bureau of Narcotic EnforcementSECTION I REQUEST INFORMATIONOffice Use Only3 Please use Adobe Acrobat
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DOH 2340 is a form from the Washington State Department of Health. It is used to report a death to the department.
DOH 2340 is the Medical Marijuana Authorization Form, and it is required to be completed by a medical practitioner for a patient to legally purchase and use medical marijuana in Washington D.C.
1. Begin by downloading a copy of the DOH 2340 form from the Washington State Department of Health website. 2. Read the instructions carefully and make sure you understand the information required. 3. Enter your personal information in the appropriate fields. 4. Enter the name and address of the individual submitting the form. 5. Enter the name and address of the facility being inspected. 6. Enter the date of the inspection. 7. Describe the type of inspection being conducted. 8. Enter the number of violations identified during the inspection. 9. Describe the corrective actions taken to address the violations. 10. Sign and date the form. 11. Submit the form to the Washington State Department of Health.
The DOH 2340 form requires the following information: name of patient, address of patient, date of birth, sex, race, ethnicity, height, weight, and a signature of the patient or guardian.
The penalty for filing DOH 2340 late is a $50 late filing fee. In addition, the business may be subject to other penalties, such as a $500 civil penalty or a criminal penalty of up to $10,000.
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