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Board of Pharmacy

Emergency Applications

These forms can be used by a pharmacist, pharmacist intern, or pharmacy technician emergency permit or courtesy license applicant. The emergency permit application is to be used for staffing purposes when a pharmacy is without the services of a pharmacist due to death, illness, or other emergency circumstance. The emergency courtesy license is to be used to respond to an urgent situation, which is defined in 12 AAC 52.110. Please refer to the ‘Authorized Emergency Courtesy License Activities’ document when filling out the emergency courtesy license application.

Emergency PERMIT

Initial Applications

Pharmacists, Technicians, and Interns Facilities

Renewal Applications

Pharmacists and Technicians Facilities

Self-Inspection Reports

Miscellaneous Forms

Pharmacists and Pharmacy Technicians: Do not sign or date your renewal form until you have completed your continuing education requirements. This requirement is clear in the text above the signature line on pharmacist and technician renewal forms. CEs completed after the date on your renewal form will be disregarded in an audit. The envelopes and postmark dates used for division correspondence become part of your permanent record.