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Reporting failure to give written prescription - s227 MPMR

This form must be used by a person or relevant manager to give notice about a prescriber’s failure to comply with a relevant provision relating to a prescription for a medicine.

A relevant provision means section 84(4), 92(3) or (4) or 100(2) or (3) of the Medicines and Poisons 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 227 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.
Should 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 227 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 by 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 http://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 details of person giving the notice
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? *
Section 227 (MPMR)
I am giving notice under s227 of MPMR of *
What type of diversion-risk medicine/s were dispensed/administered after receiving a digital copy of a prescription?

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.

Diversion-risk Medicine
Unit description
Strength
Strength unit
Total number of units

What type of S8 or S4 medicine/s were orally prescribed for dispensing or giving as a treatment dose?

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.

S8 or S4 Medicine
Unit description
Strength
Strength unit
Total number of units

What type of S8 medicine/s were orally prescribed for administration?

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.

S8 Medicine
Unit description
Strength
Strength unit
Total number of units

Did you contact the prescriber to request a written prescription? *
If yes, please provide details
What was the outcome of these actions? *
Please provide details of the prescriber?
Is there any supporting evidence available?
If yes, please ensure a copy of all supporting evidence is saved and available upon request if required.
Is there any further information that you are able to provide that may be relevant to this notice?
Certification *

MPMR-227, Version 1

Last updated: 23 November 2021