Report an Adverse Drug Event to the FDA

• MedWatch Form

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

• Requisition Form

Return Form for Returning Medication to Pharmacy from Clinics

• Clinic Pharmacy Return Form

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

• Pyxis Access Request Form

Pyxis Controlled Substance Waste Documentation
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 pharmacy evaluate if product is viable for use.

• Refrigerated Medication Loss Report Form