Reporting system breaches for monitored medicines - s192 MPMR

Section 192 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) requires a system manager, or a system administrator, of an entity’s electronic prescription management system to give notice to the chief executive in the approved form if they become aware of an incident in which the system may have been unlawfully accessed or otherwise unlawfully used to obtain a monitored medicine/s.

This form must be used by the system manager or system administrator to give notice to the chief executive unless the manager or administrator has a reasonable excuse.

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 192 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 192 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

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

First name *

Last name *

AHPRA registration (if applicable)

Role within the business / organisation *

Contact number *

Email address *

Business / organisation details

Business / organisation name *

Street address

Suburb *

State

Postcode

Is the contact number different to the one you provided earlier? *

Contact number (alternate)

Is the email address different to the one you provided earlier? *

Email address (alternate)

Section 192 (MPMR)

I am giving notice under section 192 of the MPMR that I *

am aware that an electronic prescription management system may have been unlawfully accessed or used to obtain a monitored medicine/s
Other

Please provide details

What is the name of the software that was used for the electronic prescription management system? *

If other, please provide details

Which of the following best describes the system breach? *

Virus software introduced to create false prescriptions
Provision of secure system identifier to unauthorised user
Suspected theft of secure system identifier by unauthorised user
Other

Please provide details

Which of the following best describes the place where the system breach occurred? *

Please provide a description of the place

What date was the system breach discovered? *

Day Month Year

Do you know what date the system breach occurred on? * if the system breach occurred between dates then select No.

Date of system breach

Day Month Year

Please provide the last date that the system was not breached and the date the system was identified as being breached.

Date the system confirmed not breached

Day Month Year

Date the system breach identified

Day Month Year

(note this could be the same or a different date to the date stated that the system not breached)

If the date the system confirmed not breached is unknown please provide reasons for why this is not known.

Is there any supporting evidence available to confirm that the electronic prescription management system may have been unlawfully accessed or used to obtain a monitored medicine/s. *

Indicate all items that may apply

Closed-Circuit Television (CCTV)
Electronic record of unauthorised access
Statements from staff
Other

If other, please provide a brief description of available information:

Has this incident been reported to the Queensland Police Service (QPS)? *

Do you have a QPS reference number for the report made?

Please enter the QPS reference number

What action/s have been taken since the incident? *

Is there any further information that you are able to provide that may be relevant to this notice? *

Please provide details of any further information

Certification *

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

MPMR-192, Version 1