Forms

Medication/HIPAA/Sharps Waste Return

Fill out this form to request pick up for your facility’s medication waste.

Facility Name(Required)

Please provide the name of your facility

Phone Number(Required)

Address(Required)

Please provide the address of your facility

Name of person filling out the form(Required)

Which type of waste return is being requested?(Required)

Medication Waste

HIPAA Waste

Sharps Waste

I have completed the Return Medication Log(Required)

This is a form that outlines every single medication/pill being returned to the pharmacy. It will be filled out and placed inside the yellow return tote.

How many small, yellow totes are needed to fit your return medication quantity?(Required)

These totes are approximately the size of the small blue delivery totes.

The Sharps container is locked closed and placed inside the red biohazard bag.

The red biohazard bag is attached to the container in a clear plastic sealed sleeve.

The HIPAA waste is in a non-transparent plastic bag that is tied/sealed shut.

IMPORTANT – PLEASE READ then type YES in field(Required)

We understand that orders for discontinued or changed medications CANNOT be sent via drivers who are independent contractors. Medication changes must be sent directly to the pharmacy. We also understand that if any waste does not meet KLTC or Department of Transportation standards for transportation of medication and/or waste containing PHI the driver will refuse transportation. Waste pickups will take place at the time of a scheduled delivery. There will not be waste/Sharps/medication only pickups.

Medication/HIPAA/Sharps Waste Return

Onboarding Paperwork