Please resolve the following issues before proceeding
Click on an issue to go directly to the related section of the form.
errors found:
warnings found:
Fee ($)
Pending licence/permit last six digits
Finalised submission date

Basic information

Licence or permit application
Fields marked with * are required
How long will this form take to complete?
The length of time it takes to complete this form may vary depending on how complicated your application is. Simple applications may take 5 minutes, and more complicated applications may take 30 minutes or more.
You can save a partially completed application by clicking the link that states “Save For Later” in the top right hand corner of the screen. After saving, you can return to the application at a later time to complete it.

Do you know what type of licence or permit to apply for?

There are three main types of licences or permits that you can apply for: A permit that may involve your organisation providing health servicesA licence to supply by wholesale (and possibly manufacture)A permit for other purposes (that may involve your organisation performing research or industrial activities)
Do you know which of these main three types of licences or permits to apply for?

Select which type of licence/permit to apply for

Does your organisation intend to carry out manufacturing activities with the substances?
What would be considered "manufacturing" activities?

Questions to determine what to apply for

Would individual items containing scheduled substances that your organisation intends to obtain ever need to be opened from their original, individual packaging by your organisation and then used or changed in some way by your organisation?
Would the scheduled items ever need to be administered to a human being by your organisation?
Would your organisation ever need to supply the scheduled substances to persons or organisations external to your organisation (other than for the purposes of waste removal)?

Health service permit confirmation

Based on your answers, it seems that your organisation may need to apply for a health service permit
To proceed to apply for a health service permit, please confirm that you understand the following points:
If you would like to provide general information in free-text regarding what you would like to apply for (in less than 800 characters), you may do so here. This is optional.

Permit for various purposes (including industry and research) - Confirmation

Based on your answers, it seems that your organisation may need to apply for a permit for purposes such as industry, research, education or advice.
To proceed to apply for such a permit please confirm that you understand the following information:
Which Schedule 7 substances would require a permit?
If you would like to provide general information in free-text regarding what you would like to apply for (in less than 800 characters), you may do so here. This is optional.

Licence to supply - Confirmation

Based on your answers, it seems that your organisation may need to apply for a licence to supply scheduled substances.
To proceed to apply for such a licence please confirm that you understand the following information:
Does your organisation intend to store any of the scheduled substances itself on premises that it owns or formally rents? (It is not necessary for a licence holder to store goods that it intends to supply itself if it can arrange for another “third party” licence holder to store the goods on its behalf).
If you would like to provide general information in free-text regarding what you would like to apply for (in less than 800 characters), you may do so here. This is optional.

Health service uses

Licence or permit application
Fields marked with * are required

What would be the best way to describe the broad type of health services provided by your organisation (only one option may be selected).

Which general health services are provided? (Note that both a general practice clinic and a hospital cannot be selected at the same time)

Would your organisation require any substances obtained using the health service permit for any purposes other than for the administration to patients, or supply to patients?
(For example, Schedule 4 substances may be required by your organisation if it were to conduct its own analysis of its patients’ pathology samples)
Would the other purposes that the scheduled substances would be required for ONLY be pathology services provided by your organisation?
Please complete the "Uses" section of this form for only those activities relating to using scheduled substances for any purposes other than for the administration to patients, or the supply to patients, or for pathology services.

Day surgery (not part of a hospital)

What day surgery service(s) would be provided?
(More than one may be selected, but do not select any that would not actually be provided.)

What specialised service(s) would be provided?
(More than one may be selected)

Confirm that your organisation either:
Enter the non-emergency patient transport licence held by your organisation
/

Over-night patient accommodation beds for patients

Would your organisation provide over-night patient accommodation beds for patients?
How many over-night patient accommodation beds would your organisation provide? (If your organisation is to use multiple sites with this single permit, then indicate the number of beds on the site that has the highest number of beds)

Substances

Licence or permit application
Fields marked with * are required

Standard medicines for specialised health services

You have indicated that the health services provided would include vaccination services.
Ordinarily, the scheduled medicines required for vaccination services would include vaccines approved to be used by nurse immunisers, as well as adrenaline necessary for the treatment of anaphylactic reactions.
Vaccines approved to be used by nurse immunisers include that for influenza, as well as those for covid-19, diphtheria, haemophilus influenzae type b, hepatitis A, hepatitis B, human papillomavirus, measles, meningococcus, mumps, pertussis, polio, rotavirus, rubella, streptococcus pneumoniae, tetanus and varicella.
You have indicated that the health services provided would include cosmetic medical services.
Ordinarily, the scheduled items required for cosmetic medical services would include: botulinum toxins, deoxycholic acid, and hyaluronic acid and its polymers; and lidocaine; as well as adrenaline necessary for the treatment of anaphylactic reactions.
You have indicated that the health services provided would include non-emergency patient transport services. Ordinarily, the scheduled medicines required for non-emergency patient transport services would include: The Schedule 4 medicines amiodarone, ipratropium, methoxyflurane, ondansetron and salbutamol;The Schedule 3 medicines adrenaline, glucagon, glyceryl trinitrate and salbutamol;The Schedule 2 medicine aspirin and paracetamol
This form was designed in May 2021. It's possible that other additional medicines may have been added to the Victorian clinical practice protocols for non-emergency patient transport providers after May 2021. If so, please consider any additional medicines included in the Victorian protocols to be included in the list above.
Would the medicines indicated above be the ones to be included on the permit?
What medicines would be required to be part of the permit?
If your organisation intends to obtain any schedule 4 medicines that are in addition to those mentioned above, the following health professionals cannot lawfully initiate the administration of any of those additional schedule 4 medicines:
Nurse immunisers
Ambulance transport attendants or ambulance officers working under a non-emergency patient transport (NEPT) licence
Only another authorised practitioner, such as a medical practitioner, may initiate the administration of the additional schedule 4 medicines.
Please complete the next main section below (entitled “Select substance(s)”) to select the substances to be included on the health service permit that are in addition to those mentioned above.
If your organisation intends to obtain any schedule 4 medicines that are in addition to those mentioned above, the following health professionals cannot lawfully initiate the administration of any of those additional schedule 4 medicines:
Nurse immunisers
Ambulance transport attendants or ambulance officers working under a non-emergency patient transport (NEPT) licence
Only another authorised practitioner, such as a medical practitioner, may initiate the administration of the additional schedule 4 medicines.
Please complete the next main section below (entitled “Select substance(s)”) to select the substances to be included on the health service permit that are in addition to those mentioned above.
Select which limited selection of scheduled medicines from those mentioned above would be required to be part of the health service permit:

Select substance(s)

Would your organisation require individual substances to be included on its licence/permit, or whole groups of substances (or both)?

Add individual substances

Select which individual substances should be included.
The highest schedule that the substance belongs to will be stated next to the substance name.
Substance
Schedule
Schedule 2 Schedule 3 Schedule 4 Schedule 4 Schedule 4 drug of dependence Schedule 7 Schedule 7 - listed-regulated Schedule 8 Schedule 9
What would the cyanide be used for?
What if I only want to obtain a substance in a very low concentration?
The total holding quantity for individual Schedule 8 or 9 substances selected above, in milligrams, is:

Add whole groups of substances

Select which whole groups of substances are to be included on the licence/permit
What are Schedule 2 substances?
What are Schedule 3 substances?
Should the licence/permit inlcude Schedule 3 pseudoephedrine (ie: a drug of dependence within Schedule 3)
What are Schedule 4 substances?
Should the Schedule 4 substances include all drugs of dependence?
.
What are drugs of dependence in Schedule 4?
What are Schedule 7 substances?
Should the Schedule 7 substances include listed-regulated Schedule 7 substances?
.
What are lsted-regulated Schedule 7 substances?
What are Schedule 8 substances?
What are Schedule 9 substances?
What should the maximum holding quantity of all Schedule 8 or 9 substances be? (in milligrams)
What about Schedule 9 substances?
What about substances within Schedules 5, 6 or 10?

Confirm drug(s) of dependence addition

Please explain why it has been requested that ALL Schedule 9 substances be included.
Schedule 9 substances are substances that have a very high risk for abuse and misuse, so their possession is prohibited by law except when required for legitimate research or analytical purposes.
Therefore, most organisations specify INDIVIDUAL Schedule 9 substances to be added, and it is very unusual for an organisation to request that ALL Schedule 9 substances be added.
You have selected one or more drugs of dependence. These may include some Schedule 4 substances, all Schedule 8 substances and all Schedule 9 substances. Drugs of dependence carry risks for possible theft, illicit use and can cause significant harm and possibly death in people when mis-used. Your organisation should carry out due diligence on any staff member that it intends to allow access to any drug of dependence. Due diligence would ensure that the person: Has not committed a drug related crime;Does not have a drug dependency or has not used recreational drugs; andHas the knowledge or practical skills necessary for the safe, secure and responsible handling of the substances.
Does your organisation want to proceed to include drugs of dependence with the application?
What would “due diligence” include?
To proceed to remove drugs of dependence from this application, un-select from your selections above any of the following substances that are marked as: Any Schedle 4 drugs of dependenceAny Schedule 8 substancesAny Schedule 9 substancesSchedule 3 pseudoephedrine

Other agency requirements

You have indicated that substances(s) related to cannabis are to be included with the application. These substances may include cannabidiol, dronabinol, nabiximols, synthetic cannabinomimetics, tetrahydrocannabinols or cannabis itself.
Would your organisation ever need to obtain any substances related to cannabis in the foreseeable future? (Such substances may include cannabidiol, dronabinol, nabiximols, synthetic cannabinomimetics, tetrahydrocannabidiol or cannabis itself.)
Would your organisation ever need to obtain the Schedule 4 substance cannabidiol in the foreseeable future? (Cannabidiol is related to cannabis.)