Section 43 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) requires the holder of a substance authority to give notice to the chief executive of Queensland Health (or delegate) if they propose to stop carrying out a dealing with a medicine under their authority — this form must be used for this purpose.
The following information must be given by the substance authority holder under section 43(2) of the MPMR:
Before completing this form, please carefully read the following Privacy Statement:
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 notice under authority of the Medicines and Poisons Act 2019. The information is being collected to ensure that health risks arising from the use of regulated substances are appropriately managed. All personal information will be securely stored and only accessible by Queensland Health. Your personal information will not be disclosed to any other third parties without consent unless the disclosure is authorised or required by 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.
This notice is managed by the Healthcare Approvals and Regulation Unit (HARU). Should you require assistance in completing this form, please email: HARU@health.qld.gov.au.
© The State of Queensland (Queensland Health) 1996-2022