Fillable Variance Renewal Form printable pdf download

VARIANCE RENEWAL FORM

BOARD OF PHARMACY RULE 6800.9900 VARIANCES

Subpart 1. Right to request variance. A person subject to the rules of the Board of Pharmacy may request that the board grant a variance from any rule of the Board of

Pharmacy.

Subp. 2. Submission and contents of request. A request for a variance must be submitted to the board in writing. Each request must contain the following information:

A. the specific rule for which the variance is requested;

B. the reason for the request;

C. the alternative measures that will be taken if a variance is granted;

D. the length of time for which a variance is requested; and

E. any other relevant information necessary to properly evaluate the request for the variance.

Subp. 3. Decision on variance. The board shall grant a variance if it determines that:

A. the variance will not adversely affect directly or indirectly, the health, safety, or well-being of the public;

B. the alternative measures to be taken, if any, are equivalent or superior to those prescribed in the part for which the variance is requested; and

C. compliance with the part for which the variance is requested would impose an undue burden upon the applicant.

The board shall deny, revoke, or refuse to renew a variance if the board determines that item A, B, or C has not been met.

Subp. 4. Notification. The board shall notify the applicant in writing within 60 days of the board's decision. If a variance is granted, the notification shall specify the period

of time for which the variance will be effective and the alternative measures or conditions, if any, to be met by the applicant.

Subp. 5. Renewal. Any request for the renewal of a variance shall be submitted in writing prior to the expiration date of the existing waiver. Renewal requests shall contain

the information specified in subpart 2. A variance shall be renewed by the board if the applicant continues to satisfy the criteria contained in subpart 3 and demonstrates

compliance with the alternative measures or conditions imposed at the time the original variance was granted.

Subp. 6. Research projects. Pharmacists desiring to participate in research or studies not presently allowed by or addressed by rules of the board may apply for approval of

the projects through waivers or variances in accordance with subparts 1 to 4.

STATE THE VARIANCE AND SITES AFFECTED:

SITE(S) AFFECTED:

NAME: ____________________________________________________________________ LICENSE #:___________________________

ADDRESS: _______________________________________________________________________________________________________

NAME: ____________________________________________________________________ LICENSE #:___________________________

ADDRESS: _______________________________________________________________________________________________________

LIST THE SPECIFIC RULE(S) COVERED BY THE VARIANCE: 6800:_________________________6800:________________________

DATE VARIANCE ORIGINALLY GRANTED __________________________________________________________________________

DATES OF VARIANCE RENEWALS _________________________________________________________________________________

PLEASE ATTACH QUALITY ASSURANCE / QUALITY IMPROVEMENT MONITORING FINDINGS TO DETERMINE OUTCOMES

OF THE VARIANCE TO ENABLE THE BOARD TO EVALUATE YOUR RENEWAL REQUEST

FOR WHAT LENGTH OF TIME IS THIS RENEWAL REQUESTED?

___ 3 MONTHS

___ 6 MONTHS

___ 12 MONTHS

___ OTHER, PLEASE LIST _________________

OTHER RELEVANT INFORMATION THE BOARD OF PHARMACY SHOULD CONSIDER ALONG WITH THIS REQUEST:

SIGNATURE: ______________________________________________________________________ DATE:________________________

10/14

Variance Renewal Form

Related Articles

Related forms

Related Categories