21 C.F.R. § 1305.05
Power of attorney
(a) A registrant may authorize one or more individuals, whether or not located at his or her registered location, to issue orders for Schedule I and II controlled substances on the registrant's behalf by executing a power of attorney for each such individual, if the power of attorney is retained in the files, with executed Forms 222 where applicable, for the same period as any order bearing the signature of the attorney. The power of attorney must be available for inspection together with other order records.
(b) A registrant may revoke any power of attorney at any time by executing a notice of revocation.
(c) The power of attorney and notice of revocation must be similar to the following format:
I, ____________ (name of person granting power), the undersigned (the registrant, if an individual; a partner of the registrant, if a partnership; or an officer of the registrant, if a corporation, corporate division, association, trust or other entity), have made, constituted, and appointed, and by these presents, do make, constitute, and appoint _____ (name of attorney-in-fact), my true and lawful attorney for me in my name, place, and stead, to execute applications for Forms 222 and to sign orders for schedule I and II controlled substances, whether these orders be on Form 222 or electronic, in accordance with 21 U.S.C. 828 and Part 1305 of Title 21 of the Code of Federal Regulations. I hereby ratify and confirm all that said attorney must lawfully do or cause to be done by virtue hereof.
I, ____________ (name of attorney-in-fact), hereby affirm that I am the person named herein as attorney-in-fact and that the signature affixed hereto is my signature.
Witnesses:
1. ________________
2. ________________
Signed and dated on the ________ day of ________, (year), at ________________.
The foregoing power of attorney is hereby revoked by the undersigned (the registrant, if an individual; a partner of the registrant, if a partnership; or an officer of the registrant, if a corporation, corporate division, association, trust or other entity). Written notice of this revocation has been given to the attorney-in-fact ____________ this same day.
Witnesses:
1. ________
2. ________
Signed and dated on the ________ day of ________, (year), at ________________.
(d) A power of attorney must be executed by:
(1) The registrant, if an individual; a partner of the registrant, if a partnership; or an officer of the registrant, if a corporation, corporate division, association, trust or other entity;
(2) The person to whom the power of attorney is being granted; and
(3) Two witnesses.
(e) A power of attorney must be revoked by:
(1) The registrant, if an individual; a partner of the registrant, if a partnership; or an officer of the registrant, if a corporation, corporate division, association, trust or other entity; and
(2) Two witnesses.
(f) A power of attorney executed under this section may be signed electronically, by any or all of the persons required to sign.