Approved form 2001-17

made under the
Drugs of Dependence Act 1989

Drugs of Dependence Act 1989—Form 4
(see s 109)

Drugs of dependence inventory
Pharmacy:  Pharmacy Stamp
Address:	
	
Name of outgoing pharmacist:	
Name of incoming pharmacist:	
Drug	Form	Strength	Quantity stated in register	Actual quantity held	Discrepancy	

	  Date:   ...  /  ...  /  ...
(Signature of outgoing pharmacist 
conducting inventory)
Inventory *Correct/*Incorrect
* Chief Health Officer notified
	  Date:   ...  /  ...  /  ...
(Signature of incoming pharmacist 
checking inventory)
*Incoming pharmacist to delete where inapplicable

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