Approved form 2001-13

made under the
Drugs of Dependence Act 1989

Drugs of Dependence Act 1989—Form 1
(see s 99)

Drug register
Location	
Drug1....................................................Strength1............................................Form1.....................................................

Date2	Name and address/location3	Dealing4	Name and Address of prescriber	No.5	In6	Out6	Balance7	Remarks8	Signature9

1	One drug, 1 strength, 1 form only per page of register.
2	Date of dealing.
3	Name and address of other party to the dealing (and that party’s agent, where applicable), or location of ward or dispensary to which or from which the drug is supplied.
4	Nature of dealing—whether manufacture, receipt, supply, administration, disposal, surrender, loss or theft.
5	No. of prescription or requisition.
6	Quantity of the drug coming in or going out.
7	Quantity of the drug still held.
8	Including—
	•  if the drug is supplied by a veterinary surgeon—species and identification details of the relevant animal; or
	•  if the drug is disposed of—signature of the drug inspector or Chief Pharmacist who authorised the disposal.
9	Signature of the person making the entry in the register.

Endnote
This form was originally in the Drugs of Dependence Act 1989, schedule 4.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from that schedule and became a form approved under the Drugs of Dependence Act 1989, section 205 (see amdts 1.1222 and 1.2223).

©  Australian Capital Territory 2001