The SMA-168: This Exception Request and Record of Justification Form must be filed by OMT's to request additional take-home medications for patients who have not yet met the requirements. It is crucial that you justify the reason for requesting this exception, including the results of the last three toxicology screens (all negative except for methadone and metabolites or positive for other specified substances).
Why file online? The ADAA SOTA strongly urges every OTP to file on-line through the confidential SAMHSA/CSAT/DPT Opioid Treatment Program Extranet, which is found at the following address:http://otp-extranet.samhsa.gov/login.aspx.
This on-line filing is the most efficient and beneficial method for all concerned, especially the patient, because the form can be submitted from any computer while guaranteeing confidentiality. it becomes especially crucial on Fridays, weekends, holidays, and under adverse conditions. There is no guarantee that you will receive a response by fax within 24 hours. As soon as you file the exception online, the SOTA and the DPT are immediately notified by email of an incoming request and can respond immediately.
How to file on-line: To get started with filing on-line SMA-168 exception requests, contact the SAMHSA OTP Exception Request Information Center at 1-866-OTP-CSAT (1-866-687-2728), or at firstname.lastname@example.org. You will receive a password and can start filing immediately.
How to fill out the Exception and Record of Justification Form: You will find below links to information about how to fill out and fill request exceptions as well as justifying the need for an exception:
Exception Request and Record of Justification Form: http://dpt.samhsa.gov/pdf/SMA-168.pdfNote: if you are going to fax the SMA-168, then you must send the document to the two following phone numbers:
SOTA: 410-402-8601CSAT DPT: 240-276-1630 Exception Request and Record of Justification Form Instructions: http://dpt.samhsa.gov/pdf/instructionsSMA168.pdfException Request and Record of Justification Information:http://www.dpt.samhsa.gov/regulations/exrequests.aspx
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464