Notice of intention to stop dealing (MPMR-43)

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:

the day the dealing is proposed to stop;
the amount of medicine that is likely to be unused on the day mentioned in paragraph (a), if any;
how the substance authority holder proposes to deal with any unused medicine.

Privacy notice

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.

Contact information

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.

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 intention to stop dealing

Date the dealing with regulated substances is proposed to stop *

Day Month Year

Reason for stopping dealing with regulated substances *

Other reason

Do you expect that you will have any unused medicines at the time of stopping dealing? *

Details of substances expected to be unused at the time of stopping dealing*

Generic name of substance	Quantity	Measure	Form	Strength

Proposal for dealing with unused regulated substances*

Does your substance authority allow you to undertake this proposed action?*

Further details of proposal for dealing with unused substances *

Please provide details of why you do not expect to have any unused medicines at the time of stopping dealing *

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.

MPMR-43, Version 1

Last updated: 4 December 2023