This form is intended to enable a pharmacist or other health practitioners to satisfy either of the following requirements by providing copies of relevant records and corresponding information.
To comply with section 32A of the Drugs Poisons and Controlled Substances Act 1981, a pharmacist who is requested or directed to supply or dispense Schedule 4 or Schedule 8 poisons or any other drugs of dependence in greater quantities or more frequently
than appears to be reasonably necessary is required to report the matter to Medicines and Poisons Regulation branch.
To comply with regulation 109 of the Drugs Poisons and Controlled Substances Regulations 2017, a pharmacist is required to retain dispensing records (and other records of supply) in a readily retrievable form for 3 years and to produce those records on demand to an authorized officer of Medicines and Poisons Regulation branch.
It is anticipated that this form will be used predominantly by pharmacists but it may be used by other registered health practitioners.
Notifications and submissions will be received and assessed by authorized officers of Medicines and Poisons Regulation - Tel: 1300 364 545 or via email firstname.lastname@example.org
: Once you have completed and submitted this form, you will be able to download a PDF copy of the completed form for your records.