Interdepartmental Forms

Requisition Form for Ordering from Pharmacy
Clinic Orders MUST be entered through the e-portal/Macola system.

• Requisition Form

Pyxis Controlled Substance Waste Documentation
The pharmacy must be contacted to obtain the form. Once completed, the form is faxed to 860-679-1231.

• HCH-2568 Controlled Substance Waste Documentation

Refrigerated Medication Loss
Complete to have the pharmacy evaluate if the product is viable for use.

• Refrigerated Medication Loss Report Form