IMP3 Self-Report

Pharmacy professionals who suspect they are at risk of being unable to practice with reasonable skill and safety due to impairment, have the right (and obligation) to ask for help when they need it. By failing to do so, they put themselves and their patients at risk. By self-reporting, the reporter may avoid possible disciplinary action by the Board that results if a complaint is made to the Board by a colleague, patient, concerned family members, etc. It is a safe bet that by the time a pharmacy professional is ready to address this type of problem, others are also concerned about the possible impairment. A self-report includes those situations where the professional reports diversion or misappropriation of a prescription drug or device for the individual’s personal use without proper medical authorization.

How Do You Self-Report

You may self report by doing one of the following:

• Fill out the online form and submit electronically; OR
• Print the self-report form and fax to a confidential fax number (515-725-0642) or mail to IMP3, 400 SW 8th Street, Suite E, Des Moines, Iowa 50309-4686; OR
• Email rebecca.carlson@iowa.gov