Louisiana Board of Pharmacy

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CDS Forms & Applications

Practitioners
This category includes licensed health care practitioners with prescriptive authority for controlled substances, including physicians [MD], podiatrists [DPM], dentists [DDS], optometrists [OD], advanced practice registered nurses [APRN], physician assistants [PA-C], medical psychologists [MP], and veterinarians [DVM].

101     Application for New CDS License for Practitioner
102     Application for Renewal of CDS License for Practitioner 

Facilities
This category includes manufacturers, distributors, locations where health care organizations deliver care to patients, as well as animal control shelters. It does not include pharmacies.

105     Application for New CDS License for Facility
106     Application for Renewal of CDS License for Facility
107     Notice of Permanent Closure of CDS License at Facility

Selected Persons & Organizations
This category includes researchers, medical sales representatives, drug detection canine handlers, animal euthanasia technicians, as well as laboratories.

110     Application for New CDS License for Selected Persons & Organizations
111     Application for Renewal of CDS License for Selected Persons & Organizations 

Pharmacies
This category includes pharmacies located within the state and licensed by the Board.

115     Application for New CDS License for Pharmacy
116     Application for Renewal of CDS License for Pharmacy for 2013 
116-L  Application for Late Renewal of CDS License for Pharmacy for 2013
117     Application for New CDS License for Automated Medication System (AMS)
118     Application for Renewal of CDS License for AMS (or AMX) for 2013-2014
118-L  Application for Late Renewal of CDS License for AMS (or AMX) for 2013-2014

For General Use
120     Notice of Change of Address for CDS License
201     Product Order Form - Duplicate Credential

Please Note: If your CDS license has been expired for more than 30 days, it is too late to renew it.  However, you can apply for the reinstatement of the license.  To do so, please send a written request to the Board office (mail, fax, or email), requesting the information necessary to reinstate the license.  Please be sure to include the name of the person, facility or organization that obtained the license, the CDS license number, and the current mailing address.  The licensing staff will prepare a reinstatement packet for you, detailing the instructions on the procedures necessary to reinstate the license.