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Reporting lost, stolen or destroyed medicine register - s218 MPMR

This form must be used to report a lost, stolen or destroyed medicine register for an S8 safe or approved store to the chief executive pursuant to section 218 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR).

You may be contacted by an inspector appointed under the Medicines and Poisons Act 2019 or an authorised delegate of the chief executive to require further information and/or for auditing/inspection purposes relevant to this notice.

If, at this stage, you are not able to provide all the information in this notice, under section 218 of the MPMR you must give as much information as possible and you can provide any additional information or a follow-up notice at a later date.  

Contact information

This notice is managed by Medicines Compliance. If you require assistance in completing this form, please email: MedicinesCompliance@health.qld.gov.au

Privacy notice

Personal information collected by Queensland Health is handled in accordance with the Information Privacy Act 2009. Queensland Health is collecting your personal information on this approved form under authority of section 218 of the MPMR. All personal information will be securely stored and only accessible by Queensland Health staff. Your personal information will not be disclosed to other third parties without consent, unless the disclosure is authorised or required under law. Failure to provide information may render the form incomplete, which may constitute an offence under the Medicines and Poisons Act 2019. For information about how Queensland Health protects your personal information, or to learn about your right to access your own personal information, please see our website at www.health.qld.gov.au/global/privacy.

Required fields are marked with an asterisk (*).
Please indicate if this is the initial notice or follow-up notice *
Please email additional information to MedicinesCompliance@health.qld.gov.au and include the initial notice Submission ID in the email title.
Please provide your details
Business / organisation details
Is the contact number different to the one you provided earlier? *
Is the email address different to the one you provided earlier? *
I am giving notice under section 225 of the MPMR that *
What form was the medicine register that was lost, stolen or destroyed? *
Was the entire medicine register lost, stolen or destroyed? *
Which of the following best describes the incident type? *
What date was the medicines register discovered as being lost, stolen or destroyed? *
Do you know what date the incident occurred on?
If yes, please provide the date of incident
Date the medicine register last accounted for
Date the medicine register identified as being lost, stolen or destroyed
Was the last address the medicines register was located at prior to the incident the same as the business / organisation address provided previously? *
Please provide details of where the medicines register was located
Is there Closed-Circuit Television (CCTV) footage available of the incident?
Please ensure a copy of the CCTV footage is saved and available upon request if required.
What action/s have been taken or will be taken in response to this incident? *
If the medicine register was kept electronically, have attempts been made to recover the file
If medicine area access review completed
Is there any further information that you are able to provide that may be relevant to this notice? *
Certification *
MPMR-218, Version 1

Last updated: 20 October 2021