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Notice of intention to attend an event (MPMR-35)

Section 35 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) requires the holder of a general approval (emergency first aid) to give notice to the chief executive of Queensland Health (or delegate) if a registered nurse, first aid provider or paramedic intends to attend an event for the holder of the general approval — this form must be used to for this purpose.

Notice must be given no less than 2 business days before the event happens.


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 226 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


Contact information

This notice is managed by HealthcareApprovals and Regulation Unit (HARU). Should you require assistance incompleting this form, please email: HARU@health.qld.gov.au

Required fields are marked with an asterisk (*).
1. Details of person making the notification
2. Details of substance authority holder making the notification
Expiry date *
3. Details of intention to attend event

Please provide details of events that you intend to attend. For more than 3 events, please submit additional forms.


3.1 Details of EVENT ONE
Date of engagement
Start time
End time
Start date of event
End date of event
Typical start time
Typical end time
Start date of engagement
End date of engagement
Times services will be provided
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

3.2 Details of EVENT TWO
Do you want to provide details of a second event? *
SECOND EVENT
*
*
Date of engagement
Start time
End time
Start date of event
End date of event
Typical start time
Typical end time
Start date of engagement
End date of engagement
Times services will be provided
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

3.3 Details of EVENT THREE
Do you want to provide details of a third event? *
THIRD EVENT
*
*
Date of engagement
Start time
End time
Start date of event
End date of event
Typical start time
Typical end time
Start date of engagement
End date of engagement
Times services will be provided
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

4. Additional information and attachments
Certification *

MPMR-35, Version 1

Last updated: 26 October 2021