Reporting and preventing use of unlawful document - s228 MPMR

Section 228 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) requires a person who is authorised to deal with a medicine to give notice to the chief executive in the approved form as soon as practicable if they are given a document for a diversion-risk medicine that they reasonably believe has been unlawfully obtained or made.

This form must be used by the authorised person to give notice to the chief executive.

Section 229 of the MPMR details the requirements for keeping and marking non-compliant paper prescriptions if the medicine is not dispensed.

By way of note, if a supplier becomes aware of an incident after providing a diversion-risk medicine, they must complete the Reporting supply on false prescriptions or purchase orders for diversion-risk medicine pursuant to section 230 of the MPMR.

An "incident" means any of the following:

false information, material to the prescription or purchase order, was given to the person who prescribed the medicine or gave the purchase order;
the prescription or purchase order was changed by a person other than—
1. for a prescription—the prescriber of the prescription or the dispenser of the medicine for the prescription; or
2. for a purchase order—the person who gave the purchase order;
the prescription or purchase order was false in any material particular.

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 228 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 228 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

Required fields are marked with an asterisk (*).

Please indicate if this is the initial notice or follow-up notice *

Initial notice
Follow up notice

Please email additional information to MedicinesCompliance@health.qld.gov.au and include the initial notice Submission ID in the email title.

Was the diversion-risk medicine dispensed/supplied? *

Yes – full
Yes – partial
No

Do not complete this notice. Complete the Reporting supply on false prescription or purchase order for diversion-risk medicines pursuant to section 230 of the MPMR.

Please provide details of authorised person giving the notice

First name *

Last name *

AHPRA registration (if relevant)

Role within the business / organisation *

Contact number *

Email address *

Business / organisation details of authorised person giving the notice

Substance Authority reference number (if applicable) e.g. substance authority number (Queensland licensees), licence or authority number (interstate licensees and Commonwealth licensees) or a pharmacy business number

Business / organisation name *

Street address *

Suburb *

State or Territory *

Postcode *

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

Contact number

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

Email address

What type of unlawful document is this notice for? *

A purchase order for stock of a medicine
A prescription

Please include details of the diversion-risk medicine/s that were on the purchase order?

Note: Schedule 2, Part 3 of the MPMR provides a list of diversion-risk medicines

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

I am giving notice under section 228 of the MPMR that I reasonably believe that

A purchase order has been unlawfully obtained
A purchase order has been unlawfully made (select all that apply)
Other

If a purchase order has been unlawfully obtained

False information appears to have been given to the person who wrote the purchase order
False name and address details appear to have been entered on the purchase order
Person seeking the purchase order has previously presented a purchase order in another name
Other

If other, please provide a brief description of incident

A purchase order has been unlawfully made

Reasonably believe the entire purchase order was fraudulent
Reasonably believe a genuine purchase order was altered

If reasonably believe the entire purchase order was fraudulent

Photocopied or scanned purchase order
Other

If other, please provide a brief description of why you reasonably believe the entire purchase order was fraudulent

If reasonably believe a genuine purchase order was altered

Additional items were added to purchase order
Date of purchase order was altered
Quantity of medicine was altered
Strength of medicine was altered
Other

If other, please provide a brief description of why you believe the purchase order was altered

If other, please provide a brief description of incident

Can you provide a copy of the purchase order?

Please attach a scanned copy and provide the purchase order details listed below

Was the person presenting the purchase order, the person for whom the purchase order was written?

Yes
No
Unsure

Can you provide the name and physical address details of the person who gave the purchase order?

Please provide details of the purported purchaser below

Please provide details of why you are unable to provide the name and address of the purported purchaser Section 228(2)(a) of the MPMR states that you must record the name and physical address of the person who gave the document. You are required to comply with this section only to the extent that it is safe for you to comply.

Please provide details of the purchaser or buyer?

First name

Last name

Type of purchaser or buyer

If other, please provide a brief details of type of purchaser or buyer

Prescriber number (if relevant)

Business/organisation name

Street address

Suburb

State or Territory

Postcode

Contact number

Email address

How was the unlawful document discovered?

Suspicious behaviour noted by staff
Poor quality purchase order
Contacted supplier to request additional information
Other

If other, please provide a brief description of how the unlawful document was discovered

Please include details of the diversion-risk medicine/s that were on the prescription?

Note: Schedule 2, Part 3 of the MPMR provides a list of diversion-risk medicines

Diversion-risk Medicine	Unit description	Strength	Strength unit	Total number of units

I am giving notice under section 228 of the MPMR that I reasonably believe that

A prescription has been unlawfully obtained
A prescription has been unlawfully made
Other

If a prescription has been unlawfully obtained

Person seeking the prescription was unable to provide photo identification
False information appears to have been given to the practitioner who wrote the prescription
False name and address details appear to have been entered on the prescription
Person seeking the prescription has previously presented a prescription in another name
Other

If other, please provide a brief description of incident

Can you provide a copy of the prescription?

If yes, please attach a scanned copy and provide the prescription details listed below

Was the person presenting the prescription, the person for whom the prescription was written?

Yes
No
Unsure

Can you provide the name and physical address details of the person who gave the prescription?

Please provide details of the purported patient below

Please provide details of why you are unable to provide the name and address of the purported patient Section 228(2)(a) of the MPMR states that you must record the name and physical address of the person who gave the document. You are required to comply with this section only to the extent that it is safe for you to comply.

Please provide details of the prescriber?

First name

Last name

Type of prescriber

If other, please provide a brief details of type of prescriber

Prescriber number (if relevant)

Business/organisation name

Street address

Suburb

State or Territory

Postcode

Contact number

Email address

How was the unlawful document discovered?

Suspicious behaviour noted by staff
Poor quality prescription
Received information from another pharmacy/pharmacist
Received pharmacy alert issued by Queensland Health
Received pharmacy alert issued by Pharmacy Guild of Australia
Contacted prescriber to request additional information
Reported by patient
Reported by member of the public
Other

If other, please provide a brief description of how incident was discovered

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

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

If yes, please enter the QPS reference number

Is there any evidence available to confirm that the document has been unlawfully obtained or made?

If yes, please ensure a copy of all supporting evidence is saved and available upon request if required

Dispensing data that relates to the incident
Statements from staff
Other

If other, please provide a brief description of available information

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

If yes, 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-228, Version 1

Last updated: 20 October 2021