This voluntary form may be used to communicate potentially forged or stolen prescription information to pharmacies/pharmacists in Washington State. Please ensure you verify as much information as possible before you submit this form to confirm your suspicion of fraud. If the situation involves a controlled substance you need to contact the Drug Enforcement Administration (DEA).The information received will be transmitted by the Commission to pharmacies in Washington. Accuracy of the information is not confirmed or verified prior to transmission.
Please take the Rx Fraud Assessment survey once you complete this survey.
Washington State Pharmacy Quality Assurance CommissionPhone: 360-2364834Fax: 360-236-2620Email us Visit our website