Supplier to notify chief executive if no receipt provided - s69 MPMR

Section 53 of the Medicines and Poisons (Medicines) Regulation 2021 (MPMR) requires a buyer to acknowledge receipt of stock of an S8 medicines by

signing the purchase order for the stock or another notice to confirm the buyer has received all of the stock; or
if the stock is delivered to the buyer – ensure a signed notice is sent to the supplier to confirm the buyer has received all of the stock.

If the stock is bought for a pharmacy, a pharmacist from the pharmacy must sign the purchase order or notice confirming receipt of the stock.

Section 68 of the MPMR requires a supplier to obtain a signed notice acknowledging receipt of the delivery.

Section 69 of the MPMR requires a supplier to give notice to the chief executive if the buyer does not provide a notice described in section 53 of the MPMR for the receipt of the S8 medicines supplied, within 5 business days after the date of delivery of a medicine.

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

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 69 of the MPMR you must give as much information as possible and you can provide any additional in formation or a follow-up notice at a later date.

Contact information

This notice is managed by Medicines Compliance. If you require assistance in completing this form, please email: [email protected]

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 69 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 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 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 [email protected] and include the initial notice Submission ID in the email title.

Please provide the suppliers details

First name *

Last name *

AHPRA registration (if applicable)

Role within the business / organisation *

Contact number *

Email address *

Business / organisation details of address where medicine/s was supplied from

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

Authority type *

If authority type other, please provide details

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

I am giving notice under section 69 of the MPMR about the following incident *

Failure of buyer to provide signed purchase order to confirm the buyer has received all of the stock of an S8 medicine within 5 business days after date of delivery
Failure of buyer to provide another notice to confirm the buyer has received all of the stock of an s8 medicine within 5 business days after date of delivery
If purchase order is given for a pharmacy, failure of pharmacist to sign purchase order or notice to confirm the buyer has received all of the stock of an S8 medicine within 5 business days after date of delivery

Please provide details of the buyer (these details should match details on the purchase order/signed notice)

Authority reference number (buyer) (if applicable)

AHPRA registration (buyer) (if applicable)

Name *

Contact number *

Email address *

Street address *

Suburb *

State or Territory *

Method of delivery

If method of deliver other, please provide details

Name of carrier (if applicable)

Date of delivery *

Day Month Year

Time of delivery

If time of delivery is other, please provide details

Please provide details of what S8 medicines/s was delivered?

Information: 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.

S8 Medicine	Unit description	Strength	Strength unit	Total number of units

What action/s were taken at the time of the delivery to obtain a signed purchase order/notice of receipt? *

Verbally requested notice of receipt from buyer
Verbal instruction given to carrier to obtain signed receipt of delivery from buyer
Written instruction given to carrier to obtain signed receipt of delivery from buyer
Other

If action/s were taken at the time of the delivery to obtain a signed purchase order/notice of receipt is other, please provide brief details

What action/s have been taken since the delivery to resolve this matter? *

Emailed request for receipt to buyer
Telephoned the buyer to request receipt
Advised buyer by email that a notice to the chief executive would be given if receipt not provided to supplier within 5 business days after the date of delivery
Verbally advised buyer that notice to the chief executive would be given if receipt not provided to supplier within 5 business days after the date of delivery
Other

If action/s have been taken since the delivery to resolve this matter is other, please provide brief details

Is there any supporting evidence available to confirm that the delivery was made?

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

Closed-Circuit Television (CCTV)
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 giving this notice, I affirm that the information I have supplied is, to the best of my knowledge, true and accurate

MPMR-69, Version 1

Last updated: 15 January 2024