CDF00034 Guest Dosing Request Logo
  • Guest Dosing Request

    To be filled out by Home Clinic
  • CompDrug 547 E 11th Avenue Columbus, OH 43211 Phone: 614.224.4506 Fax: 614.291.0118
  • Medication Hours Mon, Thurs, & Fri: 6am - 1pm Tues & Wed: 530am - 1pm Saturday: 6am - 9am Sunday: Closed
  • Patient Information

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  • Clinic Information

  • Medication Information

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  • Click Here for Transfer Criteria
  • Per CompDrug's Medical Director, patients can guest dose for a maximum of 14 days. Picture ID is required Cost: $20 per day (correct change, money order, or credit card) Payment is required on day of service This form must be completed & returned prior to medication Please notify CompDrug if guest dosing services are canceled A Release of Information MUST accompany this request A lock box is required on Saturday for Sunday & Holiday take-home medication Lock box must be ALL metal with key or combination lock No take-home medication is given for guest dosing with the exception of Sundays and holidays We will not guest dose above 200mgs of Methadone a day
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  • Prohibition on Re-Disclosure 42 CFR part 2 prohibits unauthorized disclosure of these records
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