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Notification of loss or theft (wholesaler) - s231 MPMR

This form must be used by a wholesaler to report the loss or theft of a diversion-risk medicine that was in the possession of the wholesaler immediately before the loss or theft to the chief executive pursuant to section 231 of the Medicines and Poisons (Medicines) Regulation (MPMR).

Section 231 applies to a person (each the wholesaler) who -

  • is authorised to supply medicines by wholesale; or
  • is a wholesale representative

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 231 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 231 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
e.g. substance authority number (Queensland licensees), licence or authority number (interstate licensees and Commonwealth licensees) or a pharmacy business number
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 231 (MPMR)
I am giving notice under section 231 of the MPMR that *
Do you know all/any of the diversion-risk medicine/s that were lost or stolen in this incident?
List all the diversion-risk medicine/s that were lost or stolen in this incident
Note: Please provide details of the known diversion-risk medicine/s that were lost or stolen in this incident. When you have identified the remaining diversion-risk medicine/s that were lost or stolen, a list of these medicine/s must be notified to the chief executive as soon as practicable via email to MedicinesCompliance@health.qld.gov.au

Information: Diversion-risk 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

Please ensure that you provide a complete list of the Schedule 8 medicine/s that were lost or stolen in this incident to the chief executive as soon as practicable via email to MedicinesCompliance@health.qld.gov.au

Which of the following best describes the place where the diversion-risk medicine/s have been lost or stolen from? *
What date was the medicine discovered as being lost or stolen? *
Do you know what date the incident occurred on? *
If yes, please provide the date of incident
Date the medicine/s last accounted for
Date the medicine/s identified as being lost or stolen (note this could be the same or a different date to the date stated that the medicine was last accounted for)
Was the last address the medicine/s were located at prior to the incident the same as the business / organisation address provided previously? *
Please provide name and address details of where the medicine/s were located in the below fields
Has this incident been reported to the Queensland Police Service (QPS)? *
Do you have a QPS reference number for the report made?
Which of the following best describes the incident type? *
If reasonably suspected loss - explained
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.
How was the incident discovered? (indicate ALL that may apply) *
What action/s have been taken or will be taken in response to this incident? *
If implemented a system of second person oversight when dealing with medicines
If completed audit of relevant medicines, were any further issues identified?
If completed audit of the Schedule 8 medicine register, were any further issues identified
If completed audit of electronic ordering systems, were any further issues identified?
If medicine access review completed, what area access strategies will be implemented?
If changes to the level of medicine stock on hand
Are current medicines policies and procedures fit for purpose
What changes are being considered to prevent similar incidents from occurring?
Premises related strategies
Is there any further information that you are able to provide that may be relevant to this notice?
Certification *
MPMR-231, Version 1

Last updated: 6 December 2021