Interdepartmental Forms

Report an Adverse Drug Event to the FDA

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

Return Form for Returning Medication to Pharmacy from Clinics

Pyxis Create/Modify/Revoke User
Department manager or authorized designee is to complete, sign and forward the original.

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

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