Approved form 2001-15

made under the
Drugs of Dependence Act 1989

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

Methadone register
Institution and location1	..........
Strength2................................................Form2..........................................Reconciliation amount3	
Quantity of methadone removed from dispensary1…………..Quantity of methadone returned to dispensary3	
Signature of administrator3……………………………………Signature of witness3	

Date4	Patient’s name	Time of administration	Name of prescriber	Dose	Balance5	Name of administrator	Ns	

								
1	Complete at beginning of shift.
2	One strength, 1 form only per page of register.
3	Complete at end of shift.
4	Date of administration.
5	Quantity of the drug still held.

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