Regulation .04 Donation Program — Donor Form.

A donor of a prescription drug or medical supply shall sign a form containing the following statements:

(1)

That the donor is the owner or the owner's representative of the prescription drug or medical supply; and

(2)

That the donor intends to voluntarily donate the prescription drug or medical supply to the Program.

The drop-off site shall:

(1)

Require that the donor form contain:

(a)

The signature of the donor or the donor's representative;

(b)

Contact information of the donor or the donor's representative; and

(c)

The date of donation;

(2)

Require that the donor form be completed before any donation;

(3)

Provide a copy of the donor form to the donor or the donor's representative; and

(4)

Maintain a copy of the donor form for 5 years.