By completing this form, you acknowledge that you are providing the personal and health information as required under the
Drugs, Poisons and Controlled Substances Act 1981 (
the Act) to the Department of Health, Victoria (
the Department) for the purpose of notifying the Department in relation to a Schedule 8 treatment permit.
The information is handled by the Department in accordance with the requirements of the Act,
Drugs, Poisons and Controlled Substances Regulations 2017 (Vic), Privacy and Data Protection Act 2014 (Vic), Health Records Act 2001 (Vic) and the Department’s
privacy policy.
The information collected by the Department:
•will be used and disclosed for the purposes of assessing a permit application;•will be used and disclosed for monitoring and compliance purposes;•may be disclosed to other relevant health practitioners when necessary to facilitate coordination of the patient's drug treatment and safe prescribing of drugs (if applicable); and•may be disclosed for any other purposes permitted by law including but not limited to reporting or investigation of suspected unlawful activity to regulatory and law enforcement agencies in the Commonwealth, States and Territories; and Ahpra.
If you do not provide all the required information, the notification may not be processed.
You can download a PDF copy of the completed form or request a confirmation email at the Submission Complete page.
For further information about Victorian Drugs and Poisons legislation, please visit the Medicines and Poisons Regulation website at
www.health.vic.gov.au/dpcs.
For further information on privacy and how to access and seek correction of personal information about you held by the Department, visit
www.health.vic.gov.au/privacy.