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Getting Started

Application for a permit to treat a patient with Schedule 8 drugs
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Do you need to complete this form?
This form is for prescribers who need to apply for a permit to prescribe Schedule 8 drugs.Do not use this form if you are a prescriber applying for a permit to treat an opioid dependent person with opioid replacement therapy. Use Application for a permit to treat a patient with opioid replacement therapy.

Note: Once you have completed and submitted this form, you will receive a confirmation email that your completed form has been received by the department, as well as a PDF of your completed form for your records.

To save time filling out the form in the future, please tick the checkbox at the end of the form to confirm that you want to save your Prescriber Details on this computer. Future use of this form on this computer will automatically populate with your Prescriber Details.

Prescriber Details

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Your details

To save time filling out the form in the future, please tick the checkbox at the end of this form to confirm that you want to save your Prescriber Details on this computer. Future use of this form on this computer will automatically populate with your Prescriber Details.

Patient Details

Application for a permit to treat a patient with Schedule 8 drugs
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Patient Details

Treatment Details

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Patient treatment details

Please select one of the following options
NOTE: If is a drug dependent person or has a history of drug dependence, please select option 3. None of the above
Select which Schedule 8 drugs you will be prescribing (more than one drug can be selected) *
NOTE: If is a drug dependent person or has a history of drug dependence or is over 18 years of age, please select option 3. None of the above
Select which Schedule 8 drugs you will be prescribing (more than one drug can be selected) *
Drug and Dosage Details *
Name of drug *
Dose form *
Dose *
Unit *
Frequency *
Medicinal Cannabis Product
Please note that additional documentation may be required before your application can be assessed (eg. evidence of Commonwealth Therapeutic Goods Administration approval to prescribe a product not listed on the Australian Register of Therapeutic Goods)
Do you have additional documentation to support your application?

Supporting documentation

Please attach your supporting documentation here
File:
Please note: You may be requested to supply additional documentation to support your application (eg. evidence of Commonwealth Therapeutic Goods Administration approval to prescribe a product not listed on the Australian Register of Therapeutic Goods)
Do you have any recent specialist report or additional information to support your application?

Supporting documentation

Please attach your supporting documentation here
File:
Please note: You may be requested to supply specialist report or additional information to support your application. To see the department's policy on issuing Schedule 8 permits, please click here.
Evidence-based practice guidelines recommend that specialist advice should be sought for patients requiring opioid doses exceeding oral morphine 100mg daily, oxycodone 60mg daily or equivalent, for the treatment of chronic non-cancer pain, or when prescribing opioids to a patient with a history of drug dependency or aberrant drug-related behaviours. Opioids should only be prescribed as part of a comprehensive pain management plan. When applying for a permit to treat a patient with an opioid, applicants may be requested by the Secretary to provide the Secretary with evidence of a pain management plan or specialist review.

The morbidity and mortality risks associated with long term opioid therapy should be discussed with the patient; in particular the increased mortality risks correlated with the prolonged use of opioids at doses exceeding 100mg daily in morphine equivalents.

Declaration

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Declaration

This application forms part of a legal document and penalties exist for providing false or misleading information.

I, confirm the information I provided in this application is true and complete to the best of my knowledge

Privacy Statement

It is a requirement of the Drugs, Poisons and Controlled Substances Act 1981 (the Act) that the information set out in this form is provided to the Department of Health & Human Services to meet statutory notification requirements, and for the issuing of permits as required under the Act. The collection, use and disclosure of the information provided will be in accordance with the law, including the provisions of the Health Records Act 2001. The information collected may be disclosed to health practitioners practising in the following health professions: medical, nursing and midwifery and pharmacy, when necessary to facilitate coordination of the patient's drug treatment and safe prescribing of drugs. For example, it may be necessary to disclose this information when another health practitioner applies for a permit or is considering prescribing a drug of dependence. The application may not be processed if all information requested on the form is not completed.

Remember Me

You can save time filling out the form by ticking the checkbox below. Your Prescriber Details will be saved and future use of this form on this computer will automatically populate with your Prescriber Details. Do not tick the checkbox below if this is a public/shared computer as it may compromise your privacy and security.
By unticking the checkbox below the Prescriber Details that have been saved on this computer will be removed.
Prescriber Details prefilled
Department of Health & Human Services