Pharmacy Closing Statement - OCPInfo.com

1 Pharmacy Closing StatementMust be filed within 30 days of a Pharmacy closingPlease review the following information to understand the professional obligations of the Designated Manager/owner when Closing a Pharmacy : person who permanently closes a Pharmacy must file a Pharmacy Closing Statement with the CollegeRegistrar within 30 days of the Closing . Drug and Pharmacies Regulation Act (DPRA), person who permanently closes a Pharmacy must immediately remove all signs and symbols relatingto the practice of Pharmacy within or outside the premises. This includes all publicly available references,including but not limited to, advertisements, webpages, media or directory listings which refer to thepremises as a Pharmacy or contain designated terms ( , drug or medicine ). DPRA, s141, person who permanently closes a Pharmacy must remove all drugs and/or dispose of all drugs in anenvironmentally safe manner. All non-controlled prescription and non-prescription drugs ( , Schedule I,II and III drugs, etc.)

2 Must be dispositioned to another accredited Pharmacy , a registered drug wholesaler, orreturned to the manufacturer. DPRA, s141, 147 Controlled Substances (Narcotics, Controlled Drugs, Targeted Substances) the disposition of a controlled substance to an accredited Pharmacy /wholesaler,Health Canada sOffice of Controlled Substances (OCS) must be notified within 10 days of Closing of the:xname and address of the receiving person and location xname and quantity of drugs xdate of the closure remaining controlled substances should be destroyed as described in the Fact Sheet -- Destructionof Narcotics, Controlled Drugs, and Targeted Substances available on the OCP related to the disposition and/or destruction of controlled substances must be retained for atleast two and Drug Regulations, Part , ; Benzodiazepines and Other Targeted Substances Regulations, s56; Narcotic Control Regulations, s40(2), 45(3); DPRA, s153 must continue to be able to access their personal health information.

3 Pharmacies are required totake reasonable efforts to give notice to patients before transferring their records or, if that is notreasonably possible, as soon as possible thereafter. If it is not reasonable to contact each individual,multiple means of providing notice should be adopted, such as, but not limited to: placing a notice on thepharmacy s website, leaving an outgoing message at the Pharmacy s telephone number, posting a noticewhere members of the public can readily view it, etc. DPRA, s157; Personal Health Information ProtectionAct, s13; OCP Guideline -- Record Retention, Disclosure, and records and documents relating to the care of a patient, including the original prescriptions, must bemaintained for a period of at least 10 years from the last recorded professional Pharmacy service providedto the patient, or until 10 years after the day on which the patient reached, or would have reached, the ageof 18 years, whichever is longer. O. Reg 264/16, s21, OCP Guideline -- Record Retention, Disclosure, andDisposalOverview Pharmacy Closing Statement Must be filed within 30 days of a Pharmacy Closing Pharmacy Information AOwner of Pharmacy /Corporation Name: Name of Pharmacy (by which the Pharmacy is known to the public): Date of Closing : (First full day the Pharmacy will be closed) Accreditation Number: Disposition of Controlled Substances (Narcotics, Controlled Drugs, Targeted Substances) B Name of Pharmacy or Wholesaler: Accreditation Number: Address: City/Town:Province:Postal Code:Email: Phone number: Disposition of Prescription Drugs (Prescription Drug List, Schedule I) Same as Section BCName of Pharmacy or Wholesaler: Accreditation Number: Address: City/Town:Province:Postal Code:Email: Phone number: Disposition of Non-Prescription Drugs (Schedule II, III, U) Same as Section CDName of Pharmacy orWholesaler:Accreditation Number:Address: City/Town:Province:Postal Code:Email: Phone number.

4 Page 1 of 2 Pharmacy Closing StatementMust be filed within 30 days of a Pharmacy Closing Same as Section DE Disposition of Patient Records Agreement Accreditation Number:Address: City/Town: Province:City/Town: Email: Phone number: Disposition of Patient Records Agreement To be completed by the Owner/Designated Manager of the Pharmacy accepting the patient records from the Closing Pharmacy . I agree to accept the patient records from the Pharmacy submitting this Closing Statement . I acknowledge that in doing so I am responsible for making these records available to patients, the College (for assessment purposes), and the Ministry of Health and Long Term Care . Signature of Owner/Designated Manager accepting records: OCP Number: Date: Email: Phone number: Removal of Signs & Symbols Relating to the Practice of Pharmacy FDate removed: Additional Comments: Closing Statement Completed by G Signature of Owner or Designated Manager: OCP Number: Date: Email: Phone number: Submit completed form by email to or by fax to 416-847-8399, or by mail to the attention of Pharmacy Applications & Renewals at 483 Huron St, Toronto, ON M5R 2R4 Version Number: Document Date: June 2018 Page 2 of 2E W LJ