Medicines usage report (MPA-70MUR)

Under Section 70 of the Medicines and Poisons Act 2019 (MPA), a substance authority is subject to any additional condition decided by the chief executive. Further, section 71 of the MPA requires that a person to whom a substance authority applies must comply with the conditions of the authority unless the person has a reasonable excuse.

Certain substance authorities granted under the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) are subject to the condition that the holder must periodically report medicines usage to the chief executive of Queensland Health (or delegate) — this form must be used for this purpose.

Collection notice

The Department of Health is collecting your information in accordance with Section 70 of the Medicines and Poisons Act 2019 in order to meet reporting requirements for a substance authority holder. 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 a Hospital and Health Service, Public Health Unit for the purpose of carrying out compliance activity. Your personal information will not be disclosed to other third parties without consent, unless the disclosure is authorised or required by or under law.

For any questions regarding this collection notice, please contact Medicines Approvals and Regulation Unit (MARU) via email: MARU@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.

Contact information

This notice is managed by the Medicines Approvals and Regulation Unit (MARU). Should you require assistance in completing this form, please email: MARU@health.qld.gov.au.

Required fields are marked with an asterisk (*).

1. Details of person making the notification

Title

Given name *

Surname *

Position *

Work phone *

Work email *

2. Details of substance authority holder making the notification

Entity name *

Substance Authority Reference *

Expiry date *

Day Month Year

Type of substance authority held

3. Details of medicines usage

Site/event/location *

Reporting period beginning

Day Month Year

Reporting period ending

Day Month Year

Provide details of any medicines held at, or taken to, the site/event/location over the reporting period

Generic name of substance	Quantity	Measure	Form	Strength

Were any medicines used during this reporting period for this site/event/location *

Provide details of any medicines used at the site/event/location over the reporting period

Date	Generic name of substance	Qualification	Prescriber's instruction	Further details
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year
Day Month Year

4. Additional information and attachments

Additional information

Upload additional supporting documents

Certification *

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

MPA-70MUR, Version 1

Last updated: 1 July 2025