For data uploaders/pharmacy users, this form is a voluntary option to provide information as it relates to meeting one of the identified exemptions according to Neb. Rev. Stat. § 71-2454(4) and Neb. Rev. Stat. § 71-2454(14)(d). The information collected in this forms is specific to the listed exemptions as they apply in 2020-2021 and form must be updated in 2021. This is not a legally binding form. The completion of this form does not guarantee your exemption from reporting to the Nebraska PDMP system. All submitted forms will be cross referenced with the current licenses according to the Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit.