Reporting lost or stolen medicine - Additional medicines - s226 MPMR

This form must be used to report additional lost or stolen medicine to the chief executive pursuant to section 226 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR). This form must only be used if there is insufficient space on the online form Reporting lost or stolen medicines - s226 MPMR | Queensland Health.

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, you must give as much information as possible and you can provide any additional information when available.

Contact information

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

Collection notice

The Department of Health is collecting your information in accordance with section 226 of the Medicines and Poisons (Medicines) Regulation 2021 for the purpose of mandatory reporting and monitoring compliance and enforcement of the legislation. Personal information collected by the Department of Health is handled in accordance with the Information Privacy Act 2009. The personal information provided by you may be disclosed to Hospital and Health Service, Public Health Units for the purpose outlined above. Your personal information will not be disclosed to other third parties without consent unless the disclosure is authorised or required by or under law. Failure to provide information may render the form incomplete, which may constitute an offence under the Medicines and Poisons Act 2019. For any questions regarding this collection notice, please contact the Medicines Compliance Team, via email MedicinesCompliance@health.qld.gov.au. For information about how the Department of Health protects your personal information, how to access or correct your own 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 of Health’s Privacy Policy.

Required fields are marked with an asterisk (*).

Please provide the Initial Notification Submission ID number *

Please provide your details

First name *

Last name *

AHPRA registration (if applicable)

Role within the business / organisation *

Contact number *

Email address *

Additional details of medicines that were lost or stolen in this incident

Information: Medicine/s should be listed using only the terms used in the Australian Standard of Uniform Scheduling of Medicines and Poisons (SUSMP/Poisons Standard). These terms do not include brand names of products, they only refer to active ingredients. If a substance is not listed in the SUSMP/Poisons Standard but is a derivative of one that is listed in the SUSMP, then select the substance that is listed

SUSMP/Poisons Standard: https://www.tga.gov.au/publication/poisons-standard-susmp

List all the additional medicine/s that were lost or stolen in this incident in the below table

Medicine	Unit description	Strength	Strength unit	Total number of units

Certification

Certification *

In giving this notice, I affirm that the information I have supplied is, to the best of my knowledge, true and accurate

Last updated: 30 June 2025