- Email a scanned copy of the signed original MAP MCSR Application form, along with copies of the requested documents, to the Drug Control Program at MAP.MCSR@mass.gov. If the MCSR Application is for a potential new site, also email the completed and signed Attestation Document. Faxed copies of the application form cannot be accepted.
- Regulations allow for non-licensed certified staff to administer medications only at sites, that are licensed, funded and/or operated by the Departments of Mental Health (DMH), Developmental Services (DDS), Massachusetts Rehabilitation Commission (MRC) and Children and Families (DCF) (Row 1).
- If for a contact person there is no address, email, or fax number; please enter “None” in each case where that applies.
- In Row 6, enter the name of the Program Director (managerial contact) responsible for the MAP site. Some service providers may have the same Program Director for multiple MAP sites. This is acceptable and the application form should be filled out accordingly. In some instances it may be preferable to have the Agency Director (Row 12) entered as the Program Director (Row 6).
- Row 12 is to be signed by the Authorized Individual (i.e., Service Provider Operational Manager: e.g., CEO, Executive Director, President, etc.) whose signature indicates the Service Provider will ensure compliance with the laws of the Commonwealth of Massachusetts and all applicable Department of Public Health rules and regulations.
Frequently Asked Questions (FAQs)
Medication Administration Program (MAP)
Massachusetts Controlled Substances Registration (MCSR) Application Form
Additional Information and Frequently Asked Questions (FAQs)
- Mail the completed and signed original MCSR Application form, along with copies of the requested documents, to the Drug Control Program, 239 Causeway Street, Suite 500, Boston, MA 02114. If MCSR Application is for a potential new site, also mail the completed and signed Attestation Document. Faxed copies of the application form cannot be accepted.
- Regulations allow for non-licensed certified staff to administer medications only at sites, that are licensed, funded and/or operated by the Departments of Mental Health (DMH), Developmental Services (DDS), and Massachusetts Rehabilitation Commission (MRC) and Children and Families (DCF) (Row 1).
- If for a contact person there is no address, email, or fax number; please enter “None” in each case where that applies.
- In Row 6, enter the name of the Program Director (managerial contact) responsible for the MAP site. Some service providers may have the same Program Director for multiple MAP sites. This is acceptable and the application form should be filled out accordingly. In some instances it may be preferable to have the Agency Director (Row 12) entered as the Program Director (Row 6).
- Row 12 is to be signed by the Authorized Individual (i.e., Service Provider Operational Manager: e.g., CEO, Executive Director, President, etc.) whose signature indicates the Service Provider will ensure compliance with the laws of the Commonwealth of Massachusetts and all applicable Department of Public Health rules and regulations.
The following FAQs may help to clarify the requirements of the registration process.
If you have further questions, please call the Drug Control Program at 617-973-0949.
Q: Why is an MCSR required for a MAP site?
A: In order to provide accountability for controlled substances, Massachusetts General Laws, Chapter 94C, section 7 and regulations of the Department of Public Health (DPH) at 105 CMR 700.004 require every person who manufactures, distributes, prescribes, administers, dispenses or possesses controlled substances to be registered. Massachusetts law recognizes prescription drugs that are not federally scheduled as Schedule VI controlled substances.
Q: What documents must be included with the MSCR application form?
A: A youth site requesting an MCSR must submit a copy of its current license(s) and a copy its current DMH contract or DCF contract. An adult site requesting an MCSR must submit a copy of its current DMH/DDS/MRC license(s) or a copy of its current DMH/DDS/MRC contract. The submitted copied document(s) must indicate the MAP Registered ‘site address’ for which the MCSR is requested. If the License or Contract does not indicate the ‘site address’ requesting registration, an additional secondary document indicating DDS/DMH/DCF/MRC support for the site address is required. To ensure that the application form is not returned, answer all questions, sign in Row 12, and submit copies of the required documents. If the MCSR Application is for a potential new site, also email MAP.MCSR@mass.gov the completed and signed Attestation Document along with the application.
Q: What address should be on the application form?
A: Two addresses are required; the Massachusetts Service Provider’s business address (Row 5) and the address of the MAP site (Row 7) for which the MCSR is requested. The business address and site address must be street addresses. If a post office box without a street address is provided, the application form will be returned. To have the MCSR certificate sent to an alternate address, please note this on the application form or in a separate letter.
Q: What constitutes amended information and the use of an Amended Application?
A: Use an Amended Application form for any changes to the contact(s) information submitted on the new or renewal MCSR application. Also, use an Amended Application form to indicate any changes in site capacity/ site occupancy. If the Service Provider Address or the Site Address has changed, a New Application form - not an Amended Application form - must be submitted.
Q: How many MCSRs are needed?
A: The MCSR is issued to the licensed Service Provider for the specific MAP location where the medication is stored. For example, a three family house has three staffed apartments and all three apartments store medications. Each apartment must obtain a separate MCSR. DPH will issue three MCSRs, one for each apartment. The name of the Service Provider will appear on all three MCSRs.
Q: When will the MCSR expire?
A: The MCSR expires one year from the date of issue. Sites must renew their registrations annually. A renewal notice will be sent to the current address that is on file with the Drug Control Program, at least six weeks prior to the expiration date