Application for Endorsement to Treat Drug Dependency

About this form

This form is to be used to apply for Endorsement to Treat Drug Dependency under the Medicines, Poisons and Therapeutic Goods Act 2008 (the Act).

Important information

The applicant should be familiar with the Act, the Medicines, Poisons and Therapeutic Goods Regulation 2008, the National Guidelines for Medication Assisted Treatment of Opioid Dependence (2014), the Controlled Medicines Prescribing Standards (Category 3) and the Opioid Maintenance Treatment in the ACT: Local Policies and Procedures.

Failure to comply with ACT legislation renders a person liable to prosecution.

Attachments

This form requires you to submit the following attachments (PDF is the preferred format):

  • One form of current photographic identification sighted and certified by an authorised witness. Please see identification requirements for important details on accepted documents.
  • A copy of training attendance certificate/s and exam results.

Your personal information

Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.