Forms for prescribers

Application for approval as a pharmacotherapy prescriber

Use the following form to apply for approval to become a pharmacotherapy prescriber following completion of the required training program.

Application for approval as a pharmacotherapy prescriber (49kb, pdf)

Permit applications

With some exceptions*, all medical practitioners must have a current permit to treat a patient for opioid dependence with methadone or buprenorphine. Permits are issued per-patient.

Application for a permit to treat an opioid dependent person with methadone or buprenorphine (62kb, pdf, complete and return by fax or mail) Application for a permit to treat an opioid dependent person with methadone or buprenorphine (Smartform, complete and return online)

* Exceptions include patients being treated in prisons or residential aged care services or as hospital inpatients. Refer to the Department of Health key legislative requirements for details. Note that an excepted patient must still be notified to the Department of Health using the same form.

Notifications

Use the following forms to notify the Department of Health of a patient’s drug dependence or to notify the department of the termination of a patient’s participation in the methadone or buprenorphine program.

Notification of drug dependent person (to submit via fax or post)Notification of drug dependent person (SmartForm – to submit online) Notification of termination of methadone or buprenorphine program (to submit via fax or post)Notification of termination of methadone or buprenorphine program (SmartForm – to submit online)