State Opioid Treatment Authority > Methadone Chain of Custody Forms

Transfer of Medications and Custody Forms

CSAT has created these forms for your use when OMT medications have to be transported due to special circumstances.  They are suited for patients who are in nursing homes, under hardship, incarcerated, homebound, medically compromised, remotely located, etc.  Some are suited for licensed persons to transport the medication, while others can be used for a person designated by the patient and/or clinic.

Methadone Chain-Of-Custody Record Residential Treatment

Methadone Chain-Of-Custody Record

Methadone Chain-Of-Custody Record Incarcerated Patient

Methadone Chain-Of-Custody Record Medically Compromised Patient-Home Bound - Transported by Approved Designee

Methadone Chain-Of-Custody Record Medically Compromised Patient-Home Bound

Methadone Chain-Of-Custody Record Homebound Patient

Methadone Chain-Of-Custody Record Medically Compromised Due to Pregnancy

Methadone Chain-Of-Custody Record Patient in Nursing Home

Methadone Chain-Of-Custody Record Remote Supervision/Travel Hardship - Transported by Patient/Administered by Significant Other

Methadone Chain-Of-Custody Record Remote Supervision/Travel Hardship

Methadone Chain of Custody Record Residential Treatment