Icompoundit

New registration form

Create your account

Only Pharmacies in Alberta can sign up. All accounts require administrator approval before access is granted.

Contact Details

Name

First Last

Phone

Username

Password

Enter Password Confirm Password

Pharmacy Details

Your Pharmacy Information

Pharmacy Name

Pharmacy License Number

Pharmacy Phone Number

Pharmacy Fax

Address Details

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Licensee Details

Pharmacy Licensee Information

Licensee Full Name

First Last

Licensee Permit Number

Licensee Email Address

Consent(Required)

I agree to the Data Sharing Agreement and Terms & Conditions

Dear Participating Pharmacy, Thank you for selecting the icompoundit.c platform (part of the OneRx suite) for your pharmacy's practice incident and close call management. Rx Incident™ helps pharmacies document and manage practice incidents, and supports de-identified data contribution to the National Incident Data Repository for Community Pharmacies (NIDR)

This Data Sharing Agreement is to be completed and submitted for any of the following:(Required)

Community Pharmacy using the icompoundit.c platform and authorizing incident data submission to the NIDR in support of your pharmacy's continuous quality improvement and medication safety obligations.

Reporting a change in the Community Pharmacy Licensee

Reporting a change in Community Pharmacy Ownership

Signature & Agreement

Complete all fields below to sign the agreement

Licensee Name

First Last

Date

Signature