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ECP
ICR 202107-1117-001 · OMB 1117-0058 · Object 113087701.
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| File Type | application/vnd.openxmlformats-officedocument.presentationml.presentation |
|---|---|
| File Title | ECP |
| Author | Shawn Firth |
| Last Modified By | Impress |
| File Modified | 2021-06-08 |
| File Created | 2026-09-11 |
| Conversion State | failed_conversion |
Extracted Text
Exempt Chemical Preparations Web Data Entry Screen Mockups v1.10 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 1 Nomenclature • Mandatory Data * • Read Only Field ECP Data Entry Forms • Web User Account Request • Company Information Change Notification • Letter of Exemptions Request • Online Question • ECP Removal Request • ECP Importer/Exporter Semi Annual Report • ECP Application • Approved Solvent Modifications Request 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 2 ECP Web User Account Request DEA Registration Number Use DEA Registration Information Company Name* Business Address* City* State/Province* Zip Code/Postal Code* Country* Type of Business* Have submitted ECP applications in the past?* - Select Yes No Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Reason for ECP Account* eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 3 Company Information Change Notification DEA Registration Number Use DEA Registration Information Company Name* Business Address* City* State/Province* Zip Code/Postal Code* Country* Type of Business* - Select - Change Applicability Date* Reason for Company Information Change* Opens Add Point Of Contact Dialog Box Add Point of Contact Points of Contact First Name Last Name George Harrison Edit Delete Paul McCartney Edit Delete Ringo Starr Edit Delete John Lennon Edit Delete Action eSignature* Submit 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 4 Add/Edit Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 5 ECP Letter of Exemptions Request DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Reason for Letter of Exemptions Request* Opens Select Exempt Chemical Preparations Dialog Box Add Exempt Chemical Preparation Exempt Chemical Preparations Product Name Form Application Date Action Control Product One Amber Vial 5ml 10/22/2015 Delete Control Product Two Amber Vial 15ml 10/22/2015 Delete Control Product Three Amber Vial 10ml 10/22/2015 Delete Control Product Four Amber Vial 25ml 10/22/2010 Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 6 • Displays all of the Exempt Chemical Preparations associated with this Company Select Exempt Chemical Preparations Select All Select Supplier Product Name Form Application Date Company One Control Product One Amber Vial 5ml 10/22/2015 Company Two Control Product Two Amber Vial 15ml 10/22/2015 Company Three Control Product Three Amber Vial 10ml 10/22/2015 Company One Control Product Four Amber Vial 25ml 10/22/2010 Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 7 ECP Online Question DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Opens Select Exempt Chemical Preparations Dialog Box 5/27/2021 Question* Add Exempt Chemical Preparation Associated Exempt Chemical Preparations Product Name Form Application Date Action Control Product One Amber Vial 5ml 10/22/2015 Delete Control Product Two Amber Vial 15ml 10/22/2015 Delete Control Product Three Amber Vial 10ml 10/22/2015 Delete Control Product Four Amber Vial 25ml 10/22/2010 Delete Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 8 ECP Removal Request DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Opens Select Exempt Chemical Preparations For Removal Dialog Box Last Name* Title* Business Email Address* Business Phone Number* Add Exempt Chemical Preparation Exempt Chemical Preparations to Remove Supplier Product Name Form Application Date Reason For Removal Company One Control Product One Amber Vial 5ml 10/22/2015 No Longer Manufactured Edit Delete Company Two Control Product Two Amber Vial 15ml 10/22/2015 No Longer Manufactured Edit Delete Company Three Control Product Three Amber Vial 10ml 10/22/2015 No Longer Manufactured Edit Delete Company One Control Product Four Amber Vial 25ml 10/22/2010 No Longer Manufactured Edit Delete Action eSignature* Submit 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 9 • Displays all of the Exempt Chemical Preparations associated with this Company Select Exempt Chemical Preparations For Removal Select All Select Supplier Product Name Form Application Date Company One Control Product One Amber Vial 5ml 10/22/2015 Company Two Control Product Two Amber Vial 15ml 10/22/2015 Company Three Control Product Three Amber Vial 10ml 10/22/2015 Company One Control Product Four Amber Vial 25ml 10/22/2010 Reason for Removal* Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 10 ECP Importer/Exporter Semi Annual Report DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Country Point Of Contact First Name* Prefilled with Company’s account information Middle Name Last Name* Title* Business Email Address* Opens Select Exempt Chemical Preparation For Semi-Annual Report Dialog Box Business Phone Number* Reporting Period Start Date* Reporting Period End Date* Semi Annual Report Comments* Add Exempt Chemical Preparation Product Name Exempt Chemical Preparations Import/Export Quantity Controlled Narcotic Substances Total Quantity Hydromorphone 30mg Diethylamide 150mg Control Product One Import 10 Control Product Three Export 30 Methaqualone Control Product Four Import 40 Amphetamine Action Edit Delete 3000mg Edit Delete 40mg Edit Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 11 • Displays all of the Narcotic Exempt Chemical Preparations associated with this Company • As each Narcotic Exempt Chemical Preparation is reported, it is removed from the list of available Narcotic Exempt Chemical Preparations to select Select Exempt Chemical Preparation For Semi-Annual Report Select Supplier Product Name Form Application Date Select Company One Control Product One Amber Vial 5ml 10/22/2015 Select Company Two Control Product Two Amber Vial 15ml 10/22/2015 Select Company Three Control Product Three Amber Vial 10ml 10/22/2015 Select Company One Control Product Four Amber Vial 25ml 10/22/2010 Report Quantity Cancel Opens Select Exempt Chemical Preparation Semi-Annual Report Quantities Dialog Box 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 12 • Displays the selected Narcotic Exempt Chemical Preparation • If the system already knows the Controlled Narcotic Substance Quantities Per Product for the Narcotic Exempt Chemical Preparation, then those values will be prefilled. If not, it is stored for the next Semi-Annual Report Exempt Chemical Preparation Semi-Annual Report Quantities Product Name Import/Export* Control Product One - Select - Quantity Shipped* Controlled Narcotic Substances Quantity Per Product* Hydromorphone - Select - Diethylamide - Select - Save 5/27/2021 Units* Cancel ECP Web Data Entry Screen Mockups v1.10 13 Exempt Chemical Preparation Application New Application for Liquid Preparation 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 14 Exempt Chemical Preparations Application DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Application Type* Opens Add Product Page Exemption Justification* Add Exempt Chemical Preparation Candidate Exempt Chemical Preparations* Supplier Opens Upload Document Dialog Box Exempt Chemical Preparation Product Name Company One Form Control Product One Amber Vial 5ml Company Two Control Product Two Amber Vial 15ml Company Three Control Product Three Amber Vial 10ml Upload Document Controlled Substances Hydromorphone Action Edit Delete Methaqualone Edit Delete Amphetamine Edit Delete Diethylamide Supporting Documentation Description Uploaded Files Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 15 • Allows a user to select a local document and upload it to the application Upload Document Document Type* - Select - Document Description* + Choose Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 16 Add/Edit Product Opens Select Manufacturer Dialog Box Product Name* Product Code Product Description Application Type* Opens Select Supplier Dialog Box New Product Manufacturer* Add Manufacturer Supplier* Add Supplier Importer Add Importer Container Add Container Opens Select Importer Dialog Box Opens Search Product Container Dialog Box Comments Opens Add Preparation Page Chemical Preparations* Add Preparation Count Preparation Action Buphedrone.HCl 1 Amber Vial 5ml Norhydrocodone-D3.HCI 1 Amber Vial 15ml Edit Delete 3,4-Methylendioxypyrovalerone-D8.HC1 1 Amber Vial 10ml Edit Delete (±)-1-( 4-Ethylphenyl)-2-methylaminopropan-1-one. HCL 1 Amber Vial 25ml Edit Delete Upload Document Edit Delete Supporting Documentation Description Uploaded Files 5/27/2021 Form Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 17 • Displays all of the Manufacturers associated with this Company Opens Add Manufacturer Dialog Box Select Manufacturer Applicant Is Manufacturer Add Manufacturer Select Company Address City Country Select COMPANY ONE 160 BIRRALEE ROAD WESTBURY AUSTRALIA Select COMPANY TWO 2 BRISBANE ROAD NORTH YORK CANADA Select COMPANY THREE 18 EINSTEIN NESS ZIONA ISRAEL Select COMPANY FOUR 2001 ODYSSEY BLVD NEW YORK USA Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 18 Add/Edit Manufacturer DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Country Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 19 • Displays all of the Importers associated with this Company Opens Add Importer Dialog Box Select Importer Applicant Is Importer Add Importer Select Company Address City State Select COMPANY ONE 160 BIRRALEE ROAD WESTBURY CONNECTICUT Select COMPANY TWO 2 BRISBANE ROAD DETROIT MICHIGAN Select COMPANY THREE 18 EINSTEIN RICHMOND VIRGINIA Select COMPANY FOUR 2001 ODYSSEY BLVD NEW YORK NEW YORK Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 20 Add/Edit Importer DEA Registration Number Company Name* Business Address* City* State* Zip Code* Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 21 • Displays all of the Suppliers associated with this Company Opens Add Supplier Dialog Box Select Supplier Applicant Is Supplier Add Supplier Select Company Address City Country Select COMPANY ONE 160 BIRRALEE ROAD WESTBURY AUSTRALIA Select COMPANY TWO 2 BRISBANE ROAD NORTH YORK CANADA Select COMPANY THREE 18 EINSTEIN NESS ZIONA ISRAEL Select COMPANY FOUR 2001 ODYSSEY BLVD NEW YORK USA Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 22 Add/Edit Supplier DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Country Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 23 • Displays all of the Product Containers associated with this Company Opens Add Product Container Dialog Box Search Product Containers Add Product Container Action Product Container Select Clone Small Box 6in x 6in x 6in Select Clone Medium Box 9in x 9in x 6in Select Clone Large Box 12in x 12in x 6in Select Clone Extra Large Box 24in x 24in x 12in Save 5/27/2021 Dimensions Cancel ECP Web Data Entry Screen Mockups v1.10 24 Opens Search Product Labels Dialog Box Add/Edit Product Container Description* Container Type* - Select - Container Dimensions* Label Add Label Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 25 • Displays all of the Product Labels associated with this Company Opens Upload Label Dialog Box Search Product Labels Add Product Label Action Product Label Description Select Product 1 Label Select Product 2 Label Select Product 3 Label Select Product 4 Label Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 26 Add/Edit Label Image Label Image File* Upload Label Download Delete Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 27 Add/Edit Preparation Description* Chemical Formula Chemical Abstracts Service Registry Number Proprietary* Yes No In-house Bulk Use* Yes No Preparation State* Liquid Minimum Fill Volume* Minimum Fill Volume Units* Units Maximum Fill Volume Maximum Fill Volume Units Opens Search Preparation Container Dialog Box Opens Search Controlled Substances Dialog Box Units Comments Add Preparation Container Preparation Containers* Action Preparation Container Volume Select Clone Ampule 5ml Select Clone Glass Vial 15ml Select Clone Flask/Carboy Select Clone Bottle 1-50L 0.5 mL-1 L Controlled Substances* Add Controlled Substance Controlled Substance Opens Search NonControlled Substances Dialog Box Opens Search Matrices Dialog Box Quantity Drug Code BETACETYLMETHADOL 26.7mg 9607 Edit CARBOXYMETHYLMORPHINE 2.467mg 9322 Edit Delete DL-2-BROMO-LSD 2400mg 7340 Edit Delete TENOCYCLIDINE HCL 16.4mg 7469 Edit Delete Delete Non-Controlled Substances Add Non-Controlled Substance Non-Controlled Substance Quantity Action AMIKACIN 25.6ng/mL Edit CHOLESTEROL 276mg/dL Edit Delete PHOSPHORUS 50mg/mL Edit Delete VANCOMYCIN 21.76ug/mL Edit Delete Delete Matrices Add Matrix Matrix Quantity Action DEFIBRINATED HUMAN PLASMA 25g/L Edit HEPES FREE ACID 14.2g/L Edit Delete CIPROFLOXACIN 5.076g/L Edit Delete PYRIDOXAL 5-PHOSPHATE 0.0057g/L Edit Delete Upload Document Delete Supporting Documentation Description Uploaded Files 5/27/2021 Action Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 28 This is an example of the Solid (Lyophilized) Preparation screen Add/Edit Preparation Description* Chemical Formula Chemical Abstracts Service Registry Number Proprietary* Yes No In-house Bulk Use* Yes No Preparation State* Solid (Lyophilized) Minimum Fill Volume* Minimum Fill Volume Units* Units Maximum Fill Volume Maximum Fill Volume Units Units Comments Add Preparation Container Preparation Containers* Action Preparation Container Volume Select Clone Ampule 5ml Select Clone Glass Vial 15ml Select Clone Flask/Carboy Select Clone Bottle 1-50L 0.5 mL-1 L Controlled Substances* Add Controlled Substance Quantity Drug Code BETACETYLMETHADOL Controlled Substance 26.7mg 9607 Edit CARBOXYMETHYLMORPHINE 2.467mg 9322 Edit Delete DL-2-BROMO-LSD 2400mg 7340 Edit Delete TENOCYCLIDINE HCL 16.4mg 7469 Edit Delete Delete Non-Controlled Substances Add Non-Controlled Substance Non-Controlled Substance Quantity Action AMIKACIN 25.6ng/mL Edit CHOLESTEROL 276mg/dL Edit Delete PHOSPHORUS 50mg/mL Edit Delete VANCOMYCIN 21.76ug/mL Edit Delete Delete Matrices Add Matrix Matrix Quantity Action DEFIBRINATED HUMAN PLASMA 25g/L Edit HEPES FREE ACID 14.2g/L Edit Delete CIPROFLOXACIN 5.076g/L Edit Delete PYRIDOXAL 5-PHOSPHATE 0.0057g/L Edit Delete Upload Document Delete Supporting Documentation Description Uploaded Files 5/27/2021 Action Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 29 This is an example of the Solid Preparation screen Add/Edit Preparation Description* Chemical Formula Chemical Abstracts Service Registry Number Proprietary* Yes No In-house Bulk Use* Yes No Preparation State* Solid Comments Add Preparation Container Preparation Containers* Action Select Preparation Container Volume Ampule Clone 5ml Controlled Substances* Add Controlled Substance Quantity Drug Code BETACETYLMETHADOL Controlled Substance 26.7mg 9607 Edit CARBOXYMETHYLMORPHINE 2.467mg 9322 Edit Delete DL-2-BROMO-LSD 2400mg 7340 Edit Delete TENOCYCLIDINE HCL 16.4mg 7469 Edit Delete Delete Non-Controlled Substances Add Non-Controlled Substance Non-Controlled Substance Quantity Action AMIKACIN 25.6ng/mL Edit CHOLESTEROL 276mg/dL Edit Delete PHOSPHORUS 50mg/mL Edit Delete VANCOMYCIN 21.76ug/mL Edit Delete Upload Document Delete Supporting Documentation Description Uploaded Files 5/27/2021 Action Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 30 • Displays all of the Preparation Containers associated with this Company Opens Add Preparation Container Dialog Box Search Preparation Containers Add Preparation Container Action Preparation Container Select Clone Ampule 5ml Select Clone Glass Vial 15ml Select Clone Flask/Carboy 1-50L Select Clone Bottle 0.5 mL-1 L Save 5/27/2021 Volume Cancel ECP Web Data Entry Screen Mockups v1.10 31 Opens Search Preparation Labels Dialog Box Add/Edit Preparation Container Description* Container Type* - Select - Container Minimum Volume* Container Minimum Volume Units* - Select - Container Maximum Volume Container Maximum Volume Units - Select - Label* Add Label Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 32 • Displays all of the Preparation Labels associated with this Preparation Opens Upload Label Dialog Box Search Preparation Labels Add Preparation Label Action Preparation Label Description Select 1ml Vial Label Select 5ml Vial Label Select 1ml – 10ml Label Select 1L – 50L Label Save 5/27/2021 Cancel ECP Web Data Entry Screen Mockups v1.10 33 • Displays all of the Controlled Substances associated with this Company Opens Add Controlled Substance Dialog Box Search Controlled Substances Add Controlled Substance Action Controlled Substance Drug Code Select Clone BETACETYLMETHADOL 26.7mg 9607 Select Clone CARBOXYMETHYLMORPHINE 2.467mg 9322 Select Clone DL-2-BROMO-LSD 2400mg 7340 Select Clone TENOCYCLIDINE HCL 16.4mg 7469 Save 5/27/2021 Quantity Cancel ECP Web Data Entry Screen Mockups v1.10 34 Add/Edit Controlled Substance Drug Name* Drug Code* Drug Schedule* Quantity Quantity Units - Select - Concentration Concentration Units - Select - Concentration Deviation Concentration Percentage Proprietary* Yes No Comments Upload Document Supporting Documentation Description Uploaded Files 5/27/2021 Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 35 • Displays all of the Non-Controlled Substances associated with this Company Opens Add Non-Controlled Substance Dialog Box Search Non-Controlled Substances Add Non-Controlled Substance Action Non-Controlled Substance Select Clone AMIKACIN 25.6ng/mL Select Clone CHOLESTEROL 276mg/dL Select Clone PHOSPHORUS 50mg/mL Select Clone VANCOMYCIN 21.76ug/mL Save 5/27/2021 Quantity Cancel ECP Web Data Entry Screen Mockups v1.10 36 Add/Edit Non-Controlled Substance Name* Quantity Quantity Units - Select - Concentration Concentration Units - Select - Adulterant Agent Yes No Denaturing Agent Yes No Active Ingredient* Yes No Proprietary* Yes No Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 37 • Displays all of the Matrices associated with this Company Opens Add Matrix Dialog Box Search Matrices Add Matrix Action Matrix Select Clone DEFIBRINATED HUMAN PLASMA 25g/L Select Clone HEPES FREE ACID 14.2g/L Select Clone CIPROFLOXACIN 5.076g/L Select Clone PYRIDOXAL 5-PHOSPHATE 0.0057g/L Save 5/27/2021 Quantity Cancel ECP Web Data Entry Screen Mockups v1.10 38 Add/Edit Matrix Name* Volume Volume Units Proprietary* - Select Yes No Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 39 Exempt Chemical Preparation Application New Application for Gel Plate Preparation 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 40 Exempt Chemical Preparations Application DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Application Type* Opens Add Product Page Exemption Justification* Add Exempt Chemical Preparation Candidate Exempt Chemical Preparations* Supplier Opens Upload Document Dialog Box Exempt Chemical Preparation Product Name Company One Form Control Product One Amber Vial 5ml Company Two Control Product Two Amber Vial 15ml Company Three Control Product Three Amber Vial 10ml Upload Document Controlled Substances Hydromorphone Action Edit Delete Methaqualone Edit Delete Amphetamine Edit Delete Diethylamide Supporting Documentation Description Uploaded Files Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 41 Add/Edit Product Product Name* Opens Select Manufacturer Dialog Box Product Code Product Description Application Type* Opens Select Supplier Dialog Box New Product Manufacturer* Add Manufacturer Supplier* Add Supplier Importer Add Importer Container Add Container Opens Select Importer Dialog Box Opens Add Product Container Dialog Box Comments Opens Add Preparation Page Chemical Preparations* Add Preparation Preparation Form Amber Vial 5ml Edit Delete Norhydrocodone-D3.HCI Amber Vial 15ml Edit Delete 3,4-Methylendioxypyrovalerone-D8.HC1 Amber Vial 10ml Edit Delete (±)-1-( 4-Ethylphenyl)-2-methylaminopropan-1-one. HCL Amber Vial 25ml Edit Delete Upload Document Supporting Documentation Description Uploaded Files 5/27/2021 Action Buphedrone.HCl Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 42 Add/Edit Preparation Description* Chemical Formula Chemical Abstracts Service Registry Number Proprietary* Yes No In-house Bulk Use* Yes No Preparation State* Gel Plate Number of Gel Plates* Comments Add Preparation Container Preparation Containers* Action Select Preparation Container Dimensions Gel Plate Box Clone 6in x 6in x 6in Controlled Substances* Add Controlled Substance Quantity Drug Code BETACETYLMETHADOL Controlled Substance 26.7mg 9607 Edit CARBOXYMETHYLMORPHINE 2.467mg 9322 Edit Delete DL-2-BROMO-LSD 2400mg 7340 Edit Delete TENOCYCLIDINE HCL 16.4mg 7469 Edit Delete Non-Controlled Substance Quantity Action AMIKACIN 25.6ng/mL Edit CHOLESTEROL 276mg/dL Edit Delete PHOSPHORUS 50mg/mL Edit Delete VANCOMYCIN 21.76ug/mL Edit Delete Delete Gel Plates Add Gel Plate Gel Plate Size AGAROSE 12.5 x 11.5 cm Upload Document Action Edit Delete Supporting Documentation Description Uploaded Files 5/27/2021 Delete Non-Controlled Substances Add Non-Controlled Substance Opens Search Gel Plates Dialog Box Action Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 43 • Displays all of the Gel Plates associated with this Company Opens Add Gel Plate Dialog Box Search Gel Plates Add Gel Plate Action Gel Select Clone AGAROSE 12.5 x 11.5 cm Select Clone CARRAGEENAN 15cm Diameter Select Clone RHAMSAN 9 x 8 cm Select Clone GELLAN 19cm Diameter Save 5/27/2021 Size Cancel ECP Web Data Entry Screen Mockups v1.10 44 Add/Edit Gel Plate Name* Shape* - Select - Size* Size Units* Opens Search Gel Mediums Dialog Box - Select - Volume Volume Units - Select - Number of Wells* Proprietary* Yes No Add Gel Medium Gel Medium Volume AGAROSE 15g/ml Action Edit Delete Comments Upload Document Supporting Documentation Description Uploaded Files 5/27/2021 Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 45 • Displays all of the Gel Mediums associated with this Company Opens Add Gel Medium Dialog Box Search Gel Mediums Add Gel Medium Action Gel Medium Select Clone AGAROSE 15g/ml Select Clone CARRAGEENAN 25g/ml Select Clone RHAMSAN 42g/ml Select Clone GELLAN 19g/ml Save 5/27/2021 Volume Cancel ECP Web Data Entry Screen Mockups v1.10 46 Add/Edit Gel Medium Name* Volume Volume Units - Select - Active Ingredient* Yes No Proprietary* Yes No Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 47 Exempt Chemical Preparation Reapplication Reapplication for previously approved Exempt Chemical Preparations 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 48 Exempt Chemical Preparations Application DEA Registration Number Company Name* Business Address* City* State/Province Prefilled with Company’s account information Zip Code/Postal Code Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Application Type* Exempt Chemical Preparation Reapplication Exemption Justification* Add Exempt Chemical Preparation Existing Exempt Chemical Preparations* Supplier Product Name Company One Form Control Product One Amber Vial 5ml Company Two Control Product Two Amber Vial 15ml Company Three Control Product Three Amber Vial 10ml Add Exempt Chemical Preparation Controlled Substances Hydromorphone Action Edit Delete Methaqualone Edit Delete Amphetamine Edit Delete Diethylamide Candidate Exempt Chemical Preparations* Supplier Product Name Form Controlled Substances Hydromorphone Action Company One Control Product One Amber Vial 10ml Edit Delete Company Two Control Product Two Amber Vial 30ml Methaqualone Edit Delete Company Three Control Product Three Amber Vial 20ml Amphetamine Edit Delete Upload Document Diethylamide Supporting Documentation Description Uploaded Files Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 49 Exempt Solvent Preparation Application 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 50 Exempt Solvents Application DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Application Type* Opens Add Product Page Exempt Solvent Exemption Justification* Add Exempt Solvent Preparation Candidate Exempt Solvent Preparations* Supplier Product Name Company One Form Control Product One Amber Vial 5ml Company Two Control Product Two Amber Vial 15ml Company Three Control Product Three Amber Vial 10ml Upload Document Controlled Substances Hydromorphone Action Edit Delete Methaqualone Edit Delete Amphetamine Edit Delete Diethylamide Supporting Documentation Description Uploaded Files Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 51 Add/Edit Product Product Name* Product Code Product Description Application Type* New Product Manufacturer* Add Manufacturer Supplier* Add Supplier Importer Add Importer Container Add Container Comments Opens Add Preparations Page Chemical Preparations* Add Preparation Preparation Form Buphedrone.HCl Amber Vial 5ml Edit Delete Norhydrocodone-D3.HCI Amber Vial 15ml Edit Delete 3,4-Methylendioxypyrovalerone-D8.HC1 Amber Vial 10ml Edit Delete (±)-1-( 4-Ethylphenyl)-2-methylaminopropan-1-one. HCL Amber Vial 25ml Edit Delete Upload Document Supporting Documentation Description Uploaded Files 5/27/2021 Action Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 52 Add/Edit Preparation Description* Chemical Formula Chemical Abstracts Service Registry Number Proprietary* Yes No In-house Bulk Use* Yes No Fill Volume* Fill Volume Units* Opens Search Solvents Dialog Box Units Comments View Solvents Add Preparation Container Preparation Containers* Action Select Preparation Container Volume Ampule Clone 5ml Controlled Substances* Add Controlled Substance Quantity Drug Code BETACETYLMETHADOL Controlled Substance 26.7mg 9607 Edit CARBOXYMETHYLMORPHINE 2.467mg 9322 Edit Delete DL-2-BROMO-LSD 2400mg 7340 Edit Delete TENOCYCLIDINE HCL 16.4mg 7469 Edit Delete Delete Non-Controlled Substances Add Non-Controlled Substance Non-Controlled Substance Quantity Action AMIKACIN 25.6ng/mL Edit CHOLESTEROL 276mg/dL Edit Delete PHOSPHORUS 50mg/mL Edit Delete VANCOMYCIN 21.76ug/mL Edit Delete Upload Document Delete Supporting Documentation Description Uploaded Files 5/27/2021 Action Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save ECP Web Data Entry Screen Mockups v1.10 Cancel 53 • Displays all of the Solvents associated with this Company Search Solvents Solvent BUPHEDRONE.HCL NORHYDROCODONE-D3.HCI 3,4-METHYLENDIOXYPYROVALERONE-D8.HC1 (±)-1-( 4-ETHYLPHENYL)-2-METHYLAMINOPROPAN-1-ONE. HCL Cancel 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 54 Exempt Solvent Preparation Reapplication Reapplication for previously approved Exempt Solvent Preparations 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 55 Exempt Solvents Application DEA Registration Number Company Name* Business Address* City* State/Province Prefilled with Company’s account information Zip Code/Postal Code Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Business Phone Number* Application Type* Exempt Solvent Reapplication Exemption Justification* Add Exempt Solvent Preparation Existing Exempt Solvent Preparations* Supplier Product Name Form Controlled Substances Hydromorphone Action Company One Control Product One Amber Vial 5ml Edit Delete Company Two Control Product Two Amber Vial 15ml Methaqualone Edit Delete Company Three Control Product Three Amber Vial 10ml Amphetamine Edit Delete Add Exempt Solvent Preparation Diethylamide Candidate Exempt Solvent Preparations* Supplier Product Name Form Company One Control Product One Amber Vial 5ml Company Two Control Product Two Amber Vial 15ml Company Three Control Product Three Amber Vial 10ml Upload Document Controlled Substances Hydromorphone Action Edit Delete Methaqualone Edit Delete Amphetamine Edit Delete Diethylamide Supporting Documentation Description Uploaded Files Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 56 Approved Solvent Modifications 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 57 Approved Solvent Modifications DEA Registration Number Company Name* Business Address* City* State/Province Zip Code/Postal Code Prefilled with Company’s account information Country Point Of Contact First Name* Middle Name Last Name* Title* Business Email Address* Opens Search Solvent Dialog Box Business Phone Number* Add Solvent Modified Solvents* Solvent Modification Reason Action Buphedrone.HCl Add Better Solvent Norhydrocodone-D3.HCI Delete No longer needed Edit Delete 3,4-Methylendioxypyrovalerone-D8.HC1 Add More Capable Solvent Edit Delete (±)-1-( 4-Ethylphenyl)-2-methylaminopropan-1-one. HCL Delete No longer needed Edit Delete Upload Document Edit Delete Supporting Documentation Description Uploaded Files Action Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete eSignature* 5/27/2021 Submit ECP Web Data Entry Screen Mockups v1.10 Cancel 58 • Displays all of the Solvents associated with this Company Opens Add Solvent Dialog Box Search Solvents Add Solvent Action Solvent Select Clone BUPHEDRONE.HCL Select Clone NORHYDROCODONE-D3.HCI Select Clone 3,4-METHYLENDIOXYPYROVALERONE-D8.HC1 Select Clone (±)-1-( 4-ETHYLPHENYL)-2-METHYLAMINOPROPAN-1-ONE. HCL Save Cancel Opens Solvent Modification Page 5/27/2021 ECP Web Data Entry Screen Mockups v1.10 59 Add/Edit Solvent Modification Name* Solvent Modification* Add Delete Reason for Modification* Comments Upload Document Supporting Documentation Description Uploaded Files Company Word Document.docx Word Document Description Download Delete Company Slide Deck.pptx Slide Deck Description Download Delete Company PDF.pdf PDF Document Description Download Delete Company Spreadsheet.xlsx Spreadsheet Description Download Delete Save 5/27/2021 Action Cancel ECP Web Data Entry Screen Mockups v1.10 60