Sch 5Infringement notice forms

Schedule 5 — Infringement notice forms [r. 148C] [Heading inserted: SL 2024/224 r. 5.] **Form 1** — **Infringement notice** - ***Medicines and Poisons Act 2014*****INFRINGEMENT NOTICE** **Infringement notice no.** - **Alleged offender** Name - Address - **Details of alleged offence** Date or period - Place - Written law contravened - Details of offence - **Date** Date of notice - **Authorised officer** Name - Signature - **Modified penalty** $_________ - **Due date for payment of modified penalty** / / (Within 28 days after the date of this notice) - **TAKE NOTICE** It is alleged that you have committed the above offence.**If you do not want to be prosecuted in court for the offence**, pay the modified penalty to the Approved Officer within 28 days after the date of this notice.**If you do not pay** the modified penalty within 28 days, you may be prosecuted or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994. Under that Act, some or all of the following action may be taken — your driver’s licence may be suspended, your vehicle licence may be suspended or cancelled, you may be disqualified from holding or obtaining a driver’s licence or vehicle licence, your vehicle may be immobilised or have its number plates removed, your details may be published on a website, your earnings or bank accounts may be garnished, and your property may be seized and sold.**If you need more time** to pay the modified penalty, you should contact the Approved Officer at the address below.Paying the modified penalty will not be regarded as an admission for the purposes of any civil or criminal court case.**If you want this matter to be dealt with by prosecution in court,** sign and date here: __________________________________ / / and send this notice to the Approved Officer at the address below within 28 days after the date of this notice.If you consider that you have good reason to have this notice withdrawn, you can write to the Approved Officer at the address below requesting that this notice be withdrawn and setting out the reasons why you consider that this notice should be withdrawn. Your letter must be received not later than 28 days after the date of this notice. - **How to pay** By post *[Insert details for paying by post]* - Online *[Insert details for paying online]* - By telephone *[Insert details for paying by telephone]* - **Method of service** **Date of service** [Form 1 inserted: SL 2024/224 r. 5.] **Form 2** — **Withdrawal of infringement notice** - ***Medicines and Poisons Act 2014*****WITHDRAWAL OF INFRINGEMENT NOTICE** **Withdrawal no.** - **Alleged offender** Name - Address - **Details of infringement notice** Infringement notice no. - Date of issue - **Details of alleged offence** Date or period - Place - Written law contravened - Details of offence - **Approved Officer withdrawing notice** Name - Signature - **Date** Date of withdrawal - **Withdrawal of infringement notice** The above infringement notice issued against you for the above alleged offence has been withdrawn.If you have already paid the modified penalty for the alleged offence, you are entitled to a refund. - *[*Delete whichever is not applicable]* * Your refund is enclosed. or* You may claim your refund by signing and dating this notice and sending it to:Approved Officer — *Medicines and Poisons Act 2014**[Insert postal and email address]* - **Your signature** Date [Form 2 inserted: SL 2024/224 r. 5.] Schedule 6 — List of Schedule 4 reportable poisons [r. 7A] [Heading inserted: SL 2024/265 r. 29.] | 1. | All benzodiazepines as specified in the current Poisons Standard Schedule 4 | | 2. | All benzodiazepine derivatives as specified in the current Poisons Standard Schedule 4 | | 3. | Codeine as specified in the current Poisons Standard Schedule 4 | | 4. | Gabapentin | | 5. | Pregabalin | | 6. | Quetiapine | | 7. | Tramadol | | 8. | Zolpidem | | 9. | Zopiclone | [Schedule 6 inserted: SL 2024/265 r. 29.] ![dline]() Notes This is a compilation of the *Medicines and Poisons Regulations 2016* and includes amendments made by other written laws. For provisions that have come into operation see the compilation table. Compilation table | **Citation** | **Published** | **Commencement** | | *Medicines and Poisons Regulations 2016* | 17 Jan 2017 p. 443‑586 | 30 Jan 2017 (see r. 2 and *Gazette* 17 Jan 2017 p. 403) | | *Health Regulations Amendment Regulations 2018* Pt. 3 | 13 Nov 2018 p. 4428‑31 | 1 Dec 2018 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations 2019* | 15 Mar 2019 p. 786-92 | r. 1 and 2: 15 Mar 2019 (see r. 2(a)); Regulations other than r. 1 and 2: 16 Mar 2019 (see r. 2(b)) | | *Health Regulations Amendment (Fees and Charges) Regulations 2019* Pt. 8 | 14 Jun 2019 p. 1883‑94 | 1 Jul 2019 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations (No. 2) 2019* | 19 Nov 2019 p. 4051-2 | r. 1 and 2: 19 Nov 2019 (see r. 2(a)); Regulations other than r. 1 and 2: 20 Nov 2019 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations 2020* | SL 2020/214 6 Nov 2020 | r. 1 and 2: 6 Nov 2020 (see r. 2(a)); Regulations other than r. 1 and 2: 7 Nov 2020 (see r. 2(b)) | | *Health Regulations Amendment (Veterinary Practice) Regulations 2022* Pt. 2 | SL 2022/93 17 Jun 2022 | 18 Jun 2022 (see r. 2(b) and SL 2022/81 cl. 2) | | *Health Regulations Amendment (Fees and Charges) Regulations 2022* Pt. 6 | SL 2022/136 15 Jul 2022 | 16 Jul 2022 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations 2023* | SL 2023/3 27 Jan 2023 | r. 1 and 2: 27 Jan 2023 (see r. 2(a)); Regulations other than r. 1 and 2: 1 Feb 2023 (see r. 2(b)) | | *Health Regulations Amendment (Fees and Charges) Regulations 2023* Pt. 7 | SL 2023/96 30 Jun 2023 | 1 Jul 2023 (see r. 2(b)) | | *Health Regulations Amendment (Fees and Charges) Regulations 2024* Pt. 7 | SL 2024/91 12 Jun 2024 | 1 Jul 2024 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations (No. 3) 2024* | SL 2024/218 30 Oct 2024 | r. 1 and 2: 30 Oct 2024 (see r. 2(a)); Regulations other than r. 1 and 2: 31 Oct 2024 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations (No. 2) 2024* | SL 2024/224 30 Oct 2024 | r. 1 and 2: 30 Oct 2024 (see r. 2(a)); Regulations other than r. 1 and 2: 31 Oct 2024 (see r. 2(b)) | | *Health Regulations Amendment (Medicines and Poisons) Regulations 2024* Pt. 2 | SL 2024/265 11 Dec 2024 | Pt. 2 (other than r. 10): 12 Dec 2024 (see r. 2(c)); r. 10: 12 Jun 2025 (see r. 2(b)) | | *Health Regulations Amendment (Fees and Charges) Regulations 2025* Pt. 7 | SL 2025/104 25 Jun 2025 | 1 Jul 2025 (see r. 2(b)) | | *Medicines and Poisons Amendment Regulations 2025* | SL 2025/212 17 Dec 2025 | r. 1 and 2: 17 Dec 2025 (see r. 2(a)); Regulations other than r. 1 and 2: 18 Dec 2025 (see r. 2(b)) | Defined terms *[This is a list of terms defined and the provisions where they are defined. The list is not part of the law.]* **Defined term Provision(s)** Aboriginal and Torres Strait Islander health practitioner 37 Aboriginal and Torres Strait Islander health worker 37 Aboriginal and Torres Strait Islander health workers 42 Aboriginal Health Service 37 access code 18(1), 147(1) acute care 3(1) agent 64(4) anaesthetic technician 37 animal 16(1) Appendix K poison 84(1) approved alternative storage arrangement 94 approved electronic prescribing system 3(1) approved form 3(1) approved needle and syringe programme 3(1) approved recipient 148E(2) approved system 142(1) ASGS 39A(1) AS/NZS 3809:1998 94 Australian Register of Therapeutic Goods 89(1) authorised person 144(1), 147(1) clinical governance committee 34(1) clinic prescriber 125 commencement day 149 co-prescriber 133 current detoxification prescriber 133 current Poisons Standard 3(1) custodial facility 114 dental hygienist 37 dental therapist 37 dental worker 47(1) dentist 3(1) detection device 94 detoxification prescriber 133 detoxification treatment 135(1) dispense 3(1) domestic commercial vessel 37 dose 94 endorsed midwife 3(1) endorsed optometrist 37 endorsed podiatrist 3(1) enrolled nurse 37 exemption 152(1) exempt substance 3(1) existing approval 154 existing authority 155 existing direction 153 existing permission 156 first aid provider (vessel) 37 foreign vessel 37 health organisation 37 health service permit 37 hospital 3(1) inappropriate use 22(1) included in the Register 6A(1) large safe 94 legally imported amygdalin 9(1) listed name 89(1) livestock export standard 49(1) medic 37 medical practitioner 3(1) medication chart 3(1) Medicines List 67(1) midwife 37 non-compliant container or label 85(1), 152(1) nurse practitioner 3(1) opioid pharmacotherapy 114 opioid pharmacotherapy prescriber 133 optometrist 37 Optometry guidelines 59(1) oral health therapist 37 oromucosal administration 6A(1) paramedic 37 patient 15(1), 16A(1), 64(4) patient in a hospital 3(1) PBS 37 PBS medicine 37 permitted purpose 74(1), 79(1) personal information 18(1) pharmaceutical sample 3(1) pharmacy intern 88(1) pharmacy technician 88(1) podiatrist 3(1) prescribing code 114 private hospital 3(1) public health programme 3(1) public health service 3(1) public health service facility 127(1) public hospital 3(1) public sector agency 79(1) qualified person 145(1) racing yacht 37 real-time prescription monitoring system 22A(1) recordable event 144(1) register 147(1) registered nurse 37 regulated Australian vessel 37 relevant health professional 22A(1) relevant medicine 22A(1) relevant premises 95(1) remote clinic 37 repealed Act 149 repealed regulations 149 repeat form 24(1) and (2) residential care chart 3(1) residential care facility 3(1) responsible person 76(1) restricted Schedule 3 poison 3(1) Schedule 2 retail licence 86(1) Schedule 4 reportable poison 3(1) Schedule 6 nitrous oxide 148D section 3(1) secure cabinet 94 small safe 94 specialist prescriber 133 specified 71, 107(1), 118(1) Standard for Optometrists 60(1) stimulant 114 stimulant clinic 125 stimulant prescriber 125 strongroom 94 structured administration and supply arrangement 3(1) supply 37 system identifier 18(1), 147(1) therapeutic use 6A(1) transdermal administration 6A(1) unauthorised person 22(1) vessel 37 veterinary nurse 37 VPB-authorised person 37 This work is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY 4.0). To view relevant information and for a link to a copy of the licence, visit www.legislation.wa.gov.au. Attribute work as: © State of Western Australia 2025. By Authority: ROGER JACOBS, Acting Government Printer