Approved form 2001-14

made under the
Drugs of Dependence Act 1989

Drugs of Dependence Act 1989—Form 2
(see s 101)

Ward register
Institution and location	
Drug1...................................................Strength1..........................................Form1..................................................................
Date2	Source of supply3/ Patient’s name	Dealing4	Name of prescriber	No.5	In6	Out6	Balance7	Dose	Time of admini-stration	Disposal7A	Remarks	Counter
signature8	Signature9	
														
1	One drug, 1 strength, 1 form only per page of register.
2	Date of dealing.
3	Name and address of supplier, or location of dispensary in class 1 institution from which the drug is supplied.
4	Nature of dealing—whether 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.
7A	Quantity (if any) disposed of.
8	•  If the drug is received—countersignature of supplier;
	•  If the drug is administered—countersignature of witness;
	•  If the drug is disposed of—countersignature of the person who authorised or witnessed the disposal.
9	Signature of the person making the entry in the register.

Endnotes
1	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).
2	This republication includes amendments made under the Legislation Act 2001, part 11.3 (Editorial changes).

©  Australian Capital Territory 2001