Contacts
Division of Health Care Facility Licensure and Certification
The Details
What you need
Please complete one form for each medication for each resident for whom you are requesting a waiver.
You must complete all information included in the Drug Waiver Request Form (RTF) and attach the most current physician progress note and most recent nursing assessment for prescription renewals.
How to request
- Download and complete the Drug Waiver Request Form (RTF)
- Fax the completed application and required attachments to (617) 753-8094
Next steps
Reviewing your request
Upon receipt of your form, Department staff will review your waiver request and return the completed waiver request form with approval or denial of your request. Forms will be returned to the fax number listed in the form.
If you have questions about a specific waiver, please contact the Survey Manager for your region.
Contact
Address
67 Forest St., Marlborough, MA 01752