Power of Attorney Form for Dea 222

POWER OF ATTORNEY FOR DEA FORM 222 (CONTROLLED SUBSTANCES ACT)

DOCUMENT CONTROL

• Effective Date: [Effective Date]
• Document Version: 3.1-PROD
• Jurisdiction / Regulatory Scope: United States Federal Law (21 CFR § 1305.05; 21 U.S.C. § 828)

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1. OFFICIAL NOTICE & REGULATORY DISCLAIMER

This is a legally binding document executed pursuant to United States Drug Enforcement Administration (DEA) regulations under the Controlled Substances Act. This Power of Attorney authorizes the designated Attorney(s)-in-Fact to sign DEA Form 222 (United States Official Order Forms - Schedules I and II). Registrants are strictly liable for all DEA Form 222 orders executed by their designated Attorneys-in-Fact. This document must be retained on-site with executed DEA Form 222 records and made immediately available for inspection by DEA Diversion Investigators.

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2. PARTIES & DEFINITIONS

A. The Registrant (Principal)

• Company / Business Entity Name: [Company Legal Name]
• DEA Registration Number: [DEA Registration Number]
• Schedules Authorized: [e.g., Schedule II, IIIN, IV, V]
• Registered Location Address: [Street Address, City, State, Zip Code]

B. The Attorney(s)-in-Fact (Agent)

• Primary Attorney-in-Fact Full Legal Name: [Primary Agent Full Legal Name]
• Primary Agent Title / Position: [Primary Agent Title]
• Primary Agent Email / Phone: [Primary Agent Contact Information]

(Optional)

• Alternate Attorney-in-Fact Full Legal Name: [Alternate Agent Full Legal Name]
• Alternate Agent Title / Position: [Alternate Agent Title]

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3. OPERATIVE CLAUSES & TERMS

1. Grant of Authority

The undersigned Registrant, being the holder of the DEA Registration Number referenced in Section 2(A), hereby formally names, constitutes, and appoints the Attorney(s)-in-Fact named in Section 2(B) as my true and lawful agent and attorney-in-fact. This appointment grants the Attorney-in-Fact full power and authority to execute and sign DEA Forms 222 (Order Forms) for the procurement of Schedule I and II controlled substances, as well as to execute electronic equivalent orders (CSOS), in accordance with 21 CFR § 1305.05.

2. Scope and Limitation of Authority

The authority granted herein is strictly limited to the execution of DEA Forms 222 and associated controlled substance ordering mechanisms. This Power of Attorney does not grant the Attorney-in-Fact the authority to modify DEA registration data, surrender registrations, manage overall facility compliance outside the scope of ordering, or execute any other legal instruments unless explicitly provided by a separate corporate instrument.

3. Ratification of Acts

The Registrant hereby ratifies and confirms all lawful acts done by the Attorney-in-Fact pursuant to the powers granted herein. This ratification binds the Registrant, its successors, and assigns as if the acts had been executed directly by the Registrant.

4. Revocation and Termination

This Power of Attorney is revocable at any time by the Registrant. This document shall automatically terminate upon:

1. The revocation of the Registrant’s DEA registration referenced herein.
2. The termination of employment or association of the Attorney-in-Fact with the Registrant.
3. The execution of a new DEA Power of Attorney document superseding this version.
4. The death, incapacity, or resignation of the Attorney-in-Fact or the individual Registrant (if a sole proprietorship).

5. Maintenance of Records

This Power of Attorney must be kept on file at the registered location alongside executed DEA Form 222 documents (or digital archives for CSOS) for the mandatory retention period of two (2) years from the date of execution, and must be available for immediate inspection by the DEA.

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4. EXECUTION & SIGNATURES BLOCK

By signing below, the Registrant and the designated Attorney(s)-in-Fact acknowledge, understand, and accept the terms, responsibilities, and legal liabilities set forth in this Power of Attorney.

Registrant (Principal) Signature

• Printed Name of Registrant / Corporate Officer: [Officer Full Name]
• Title of Corporate Officer: [e.g., President, CEO, Pharmacist-in-Charge]
• Signature: ____________________________________________________
• Date: [Date of Execution]

Acceptance by Attorney(s)-in-Fact

I, the undersigned Attorney-in-Fact, hereby accept the appointment and confirm that I understand the statutory obligations associated with signing DEA Form 222 on behalf of the Registrant.

• Primary Attorney-in-Fact Signature: _________________________________
• Printed Name: [Primary Agent Full Legal Name]
• Date: [Date of Execution]

(Optional Alternate Agent)

• Alternate Attorney-in-Fact Signature: ________________________________
• Printed Name: [Alternate Agent Full Legal Name]
• Date: [Date of Execution]

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5. STEP-BY-STEP EXECUTION GUIDE

1. Verify Registration Data: Ensure the DEA Registration Number, company legal name, and registered address exactly match the current active DEA certificate before signing.
2. Execute Signatures: The corporate officer/registrant and the designated agent(s) must physically or digitally sign and date the document. Note that two witnesses are traditionally recommended (though not strictly mandated by federal law, it is a best practice for corporate governance).
3. Record Retention: Attach this executed document directly to your active DEA Form 222 file or electronic order management system. Do not mail this document to the DEA; it must be retained on-site for inspection purposes.
4. Update Upon Personnel Changes: If the Attorney-in-Fact leaves the organization or changes roles, execute a formal revocation and issue a new Power of Attorney immediately.