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Attachment 2 - Updated self-assessment forms with proposed changes to the forms
reflected in yellow highlight
- Community Pharmacy/Hospital Outpatient Pharmacy
Self-Assessment Form
17M-13, California Code of Regulations (CCR), Title 16, Section 1715(c)
- Hospital Pharmacy Self-Assessment Form 17M-14, CCR,
Title 16, Section
1715(c)
- Wholesaler/Third-Party Logistics Provider Self-Assessment Form 17M-26,
CCR, Title 16, Section 1784(c)
- Automated Drug Delivery System Self-Assessment Form
17M-112, CCR, Title
16, Section 1715.1
- Surgical Clinic Self-Assessment Form 17M-118,
Business and Professions
Code Section 4192