Pharmacist prescriber number registration form

This form is for community pharmacists who require a Queensland community pharmacist prescriber number (prescriber number) to provide the Hormonal contraception service and/or the General health services as described in the Extended Practice Authority – Pharmacists and/or the Chronic conditions management pilot services as described in the Extended Practice Authority - Pharmacists – Community pharmacy chronic conditions management pilot.

This form cannot be used to register to participate in the Queensland Community Pharmacy Chronic Conditions Management Pilot.

Pharmacists seeking to be authorised for the Chronic Conditions Management Pilot must separately apply through the Pilot registration form. A prescriber number will be allocated through this application process, if the applicant does not already hold a prescriber number.

Use this form to:

• apply for a new prescriber number
• update an existing prescriber number
• remove a prescriber number.

Refer to the Prescriber number factsheet for further information about this process.

This form should only be completed by community pharmacists who meet the requirements for the prescribing service that they intend to deliver, as set out in the relevant sections of the:

• Extended Practice Authority – Pharmacists
• Extended Practice Authority – Pharmacists - Community pharmacy chronic conditions management pilot

This form is not able to be saved and must be submitted before closing the browser.

If you experience any issues with completing this form, please contact the Office of the Chief Allied Health Officer at QLD-pharmacyscopepilot@health.qld.gov.au.

Required fields are marked with an *

Privacy and information collection notice

The Department of Health (the Department) is collecting your information for the purposes of providing a Queensland community pharmacist prescriber number (prescriber number) to pharmacists that meet the requirements to deliver prescribing services in Queensland. Personal information collected by the Department is handled in accordance with the Information Privacy Act 2009.

Your personal information (limited to your full name, AHPRA number and prescriber number) will be searchable on the public Queensland Community Pharmacist Prescriber Register (the prescriber register). The details that will be visible on the prescriber register will include your full name and AHPRA number, along with the prescribing services that you have met the requirements to provide. Your contact details will be used by the Department for the purposes of communication and updates relevant to pharmacist prescribers.

Your personal information will not be disclosed to other third parties without consent unless the disclosure is authorised or required by or under law. If personal information is not provided, the Department will be unable to process the application for a prescriber number.

For any questions regarding this collection notice, please contact us via email at QLD-pharmacyscopepilot@health.qld.gov.au. For information about how the Department protects your personal information, how to access or correct your personal information, or how to make a complaint about a breach of the privacy principles and learn how we deal with such a complaint, please refer to the Department’s Privacy Policy.