Join the Medication Harm Prevention Network (MHPN)

The MHPN represents an array of organizations that support prevention of medication injuries and deaths with deliberate action at the local community level. Being a part of the MHPN, shows an organization’s commitment to building stronger pharmaceutical drug disposal options, drug safety monitoring and/or consumer education delivery.

To participate, please complete the below form. A project representative will then be in touch to verify your interest and share next steps. To become a corporate sponsor of MHPN, please do not complete this form – – email contact@safestdrug.org.

Your Name *

First

Last

Organization *

Email *

Phone

City *

State *

Website

Is your organization okay with being listed on our website as participating in the MHPN? *

• Yes
• No
• Please contact me to discuss

You would be listed on a visual map of MHPN participating organizations.

Can we acknowledge your MHPN participation on social media? *

• Yes
• No
• Please contact me to discuss

Do you have a pharmaceutical drug disposal kiosk, bin or other disposal options available at your location for general public access? *

• Yes
• No, but we are interested (or) are making plans to offer
• No, we are unable to support pharmaceutical drug disposal at our location

Can you offer educational materials (ex. brochures, flyers) at your location ? *

• Yes, we are interested
• Yes, we are already providing medication education resources
• No, we can't at this time
• Possibly, please contact me to discuss

Pharmaceutical drug issues are under-reported by the American public. This hampers detection and mitigation of medication harm. To help improve reporting, are you willing to make available FDA MedWatch Consumer Voluntary Reporting forms (hard copies or via link on your website) so that individuals can report their concerning adverse drug experiences directly to the FDA? *

• Yes, we are interested
• Yes, we are already doing this
• No, we can't at this time
• Possibly, please contact me to discuss

Do you know of any other organizations who may want to participate in the MHPN? (If yes, please provide their name and whether or not you want your referral to remain anonymous)

Are you authorized to sign up on behalf of your organization? *

• Yes
• No
• Please contact me to discuss

How did you find out about MHPN?

Is there anything else you would like to share?

Submit

About

Safest Drug is a 501(c)(3) non-profit organization founded in 2019.

EIN/Tax ID# 83-3185362

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contact@safestdrug.org

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