PA Prescription Drug Diversion: Suspicious Activity Report

The below form is provided for health care providers (e.g. physician, pharmacist, hospital, etc.) and the general public to report suspicious activity involving prescription medication. For example: fraudulent, stolen, or altered prescriptions, a suspicious doctor/pharmacy or an individual obtaining prescription drugs for any purpose other than the treatment of an existing medical condition, such as for purposes of misuse, diversion, or illegal distribution.

  • Suspicious Person(s) Information (If Known)

  • Address * Required
  • Complaint Information