*I confirm I am 18 years or older.Yes, I am 18 years or older*
Thank you for your application/notification under the Special Access Scheme. The TGA collects personal information, including personal details of the prescribing health practitioner and/or submitter to assess the application and contact the health practitioner or submitter where necessary.
With the exception of applications and notifications for medicinal cannabis products, the TGA does not collect the name or contact details of patients and seeks to limit the collection of patient information to what is clinically necessary. For example, the TGA may collect information relating to patients including initials, Medical Record Number (MRN), date of birth (DOB), gender and diagnosis.
With applications for medicinal cannabis products, this online system allows health practitioners to concurrently submit applications to State and Territory authorities with responsibilities for therapeutic goods. For such applications, additional personal information such as full name and residential address of the patient may be collected to satisfy the requirements of the relevant jurisdiction. Please note that once this information specific to the state or territory application has been provided to any relevant State or Territory authority, it will not be available in the online system and will not be visible to other users.
Please note that the application/notification containing your personal details may be viewed by other registered users of the system at the place you work. Generally, these users may access the application/notification for the purpose of processing the application including supplying goods under the application/notification or for the purposes of continuing patient care.
If you are a prescribing health practitioner, your name may be disclosed to State and Territory authorities with responsibility for therapeutic goods or health practitioner registration. Otherwise, and for all registered users, your personal information will only be disclosed with your consent, where authorised or required by law or as otherwise permitted under the Privacy Act 1988.
For general information about privacy, go to: https://www.tga.gov.au/privacy.
In submitting this application/notification, I consent to the collection, use and disclosure of my personal information as set out above.
In the case of applications and notifications for medicinal cannabis products, I confirm that:
the patient, or the patient’s parent or guardian (if applicable), has given their consent that the patient’s personal information will be collected and used for the purpose of this application or notification; and
the patient, or the patient’s parent or guardian (if applicable), has given their consent that the patient’s personal information may be disclosed to relevant State/Territory authorities with responsibilities for therapeutic goods and health practitioner conduct for the purposes of ensuring lawful supply of the product in that jurisdiction.