In Schedule 2 to the Principal Regulations, after Form 6 insert —
" FORM 7
Regulation 17A
Drugs, Poisons and Controlled Substances Regulations 2017
NOTICE OF INTENTION TO PRESCRIBE, AUTHORISE TO ADMINISTER, OR ADMINISTER SCHEDULE 8 MDMA OR SCHEDULE 8 PSILOCYBINE
Section 1: Psychiatrist or medical practitioner's details
First name and surname
Practice address
Qualifications
Health Practitioner Regulation National Law registration number
TGA Authorised Prescriber approval number (if applicable)
Phone number
Email address
Section 2: Person's details
First name and surname
Address
Date of birth
Sex
Name and address of site where the person is receiving treatment
Substance details
Name of substance
Proprietary name (if available)
Dose form and strength
Maximum dose and frequency
Anticipated date(s) of administration
Local Australian supplier details
Name and address of local Australian supplier (e.g. pharmacy or wholesaler)
Details of other treatment (if applicable)
Name of Clinical Trial (if applicable)
Clinical Trial Notification ID/Clinical Trial Approval ID (if applicable)
Ethics approval number (if applicable)
Name of Human Research Ethics Committee that granted the ethics approval (if applicable)".
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