Templates › Forms › SEO page

Run: DEA Form 222 / CSOS Ordering and Receipt Documentation

DEA Form 222 / CSOS Ordering and Receipt Documentation records Schedule I and II controlled substance orders, receipt checks, and sign-off in one audit-ready...

Fill this out, get a PDF emailed to you. No account required. Want to run it with your team and track results? Sign up free →

Order Identification

Order Method (required)

Order Date (required)

DEA Registration Number (required)

Enter the registrant's DEA registration number associated with this order.

Supplier / Distributor Name (required)

Order Reference Number (required)

Enter the DEA Form 222 serial number or CSOS order reference number.

Order Status (required)

Controlled Substance Details

Drug Name (required)

Schedule (required)

Dosage Form

Strength

Package Size

Quantity Ordered (required)

Enter the number of units, packages, or dosage units ordered.

Receipt Verification

Receipt Date (required)

Quantity Received (required)

Condition on Receipt (required)

Discrepancy Type

Shown when the receipt is not fully matched to the order.

Receiving Notes

Document any variance, partial fill, or follow-up needed. Do not include unnecessary PII.

Receiving Sign-Off

Received By (required)

Title / Role

Verified Against Order (required)

Confirm the shipment was checked against the DEA Form 222 or CSOS order record.

Yes No N/A

Signature (required)

Attestation

By submitting, you attest that this record accurately reflects the order and receipt verification performed and will be retained according to your organization's controlled substance recordkeeping policy.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Generated with MangoApps Templates — browse 250+ free