Self-Assessment Process

Business and Professions Code (BPC) Section 4040.6 provides that “self-assessment process” means the process of self-evaluation of a facility’s compliance with state and federal laws as a means to promote compliance through self-examination and education. The section further provides that the self-assessment process shall be performed on a form approved by the Board in consultation with stakeholders and posted on its internet website.

BPC Section 4102 sets forth specific requirements for completing the self-assessment process and generally requires that the process be completed by July 1 of every odd-numbered year.  The section also identifies other circumstances that trigger the need to complete a new self-assessment.  Note: The self-assessment process for surgical clinics is also described in BPC Section 4192.

Below are links to the current Board-approved forms.  The Board will issue a subscriber alert whenever updated forms are released.

Self-Assessment Forms

• Automated Drug Delivery System Self-Assessment (17M-112, 4/25) (PDF)
• Community Pharmacy / Hospital Outpatient Self-Assessment (17M-13, Rev. 1/26) (PDF)
• Compounding Self-Assessment (17M-39 Rev. 1/2022) (PDF)
• Hospital Pharmacy Self-Assessment (17M-14, Rev. 4/25) (PDF)
• Surgical Clinic Self-Assessment (17M118, Rev. 1/24) (PDF)
• Wholesaler Self-Assessment (17M-26, Rev. 4/25) (PDF)