S.L. 101.2 Art. 18Prescriptions, records, etc. Name I request Name and Private address (IN BLOCK Signature Supplied Serial No. (a) If (b) If Forwarded A.R. Card to applies Form in which obtained applies When sale is on prescription, specify the ingredients or in the prescriptions and insert the official serial number

Prescriptions, records, registers or other documents required to be retained or kept in pursuance of the Ordinance or of any of these Rules shall be preserved for not less than two years from the date of the prescription or document or the last entry in the record register, as the case may be, and shall be kept at all times available for inspection in accordance with the provisions of the Ordinance. Added by: G.N. 545 of 1957. Substituted by: FIRST SCHEDULE L.N. 40 of 1984. Amended by: (Rules 6 and 7) L.N. 23 of 1985.

PRESCRIPTION FOR NARCOTIC AND PSYCHOTROPIC DRUGS (Only one item may be prescribed on this Form)

A. TO BE FILLED BY PRESCRIBER C. TO BE FILLED BY DISPENSING APOTHECARY PATIENT Name and Surname ................................................................. PATIENT Address ................................................................................... Surname ITEM Quantity (incl. Form& Dose) I.D Directions for use Additional information in respect of Prescriptions for METHADONE Male Female

ITEM Expected Duration of Treatment .................... Quantity Supplied Medical Indication ........................................ Total Quantity in Units ............................................................... PRESCRIBER Med Council Reg. No. Total Quantity in Weight/Measure ............................................... Name and Surname .......................................................... PRESCRIPTION ORIGIN Address .......................................................................... Hospitals .............................................................

Signature ............................................... Date .................... Govt. Clinics ....................................................... .. Private ....................................................... .. B. FOR OFFICIAL USE ONLY DISPENSER To be filled by Government Dispenser Signature................................................................ . PRESCRIPTION TYPE Pharmacy Board Reg. No Pink Form Schedule III Others Dispensary Address Direct Postal .........................................................................

LOCATION DISPENSER Dispensary

To be filled by Coder DH Licence No.

Item No. Prescription Origin Date

Serial No. REQUEST FOR PRESCRIPTION FORMS FOR NARCOTIC AND PSYCHOTROPIC DRUGS

.................... booklet/s by .................. prescription forms. surname of prescriber .................................................... (IN BLOCK LETTERS) ..................................................................................................... LETTERS) .......................................................................................................

.................. Med. Council Reg. No.

FOR OFFICIAL USE

................... booklet/s by ................... prescription forms.

........................ to ........................ withdrawn personally by prescriber.

........................................... ................................... Signature of Prescriber Date forwarded by mail. by .................................... on ...........................

be attached. Amended by: L.N. 40 of 1984; L.N. 23 of 1985. SECOND SCHEDULE

(Rule 11)

A.Register of Drugs to which Part V of the Dangerous Drugs Ordinance Purchased or otherwise obtained

Name of Name of Address of Date on substance person, body person, body which purchased or or firm from or firm from Amount supply otherwise whom whom obtained received obtained obtained obtained

B.Register of Drugs to which Part V of the Dangerous Drugs Ordinance

Sold or supplied.

Address ofperson, Name of Authority of Name of Date on body or Form person, body person, body Amount substance which the firm to which or firm to or firm to bein sold or sold or transaction whom or sold or whom sold possession of supplied supplied was effected which supplied or supplied the substances sold or supplied

THIRD SCHEDULE Substituted by: L.N. 4 of 1974. (Rule 14)

Council constituted under article 20 of the Department of Health Ordinance shall be the tribunal for the purposes mentioned in sub-rule of these Rules.

FOURTH SCHEDULE

(Rule 17) Preparations exempt from the Rules Idoformi et Mophineae, B.P.C. ’23

Diamorph. et Terpin. c. Apomorph., B.P.C. B.P. ’98. Diamorph. Camph., B.P.C.

Diamorph. c. Ipecac., B.P.C. Diamorph. et Scill., B.P.C. B.P. ’14.

Ammon., B.P.C. ’23. Arsenicals, B.P.C. et Opii Co., B.P.C. ’23.

c. Cret. et Opii, B.P.C. c. Opio, B.P.C. ’23. c. Scill., B.P. ’14.

c.Opio. B.P. ’14. Aromat. c. Opio, B.P. et Opii, B.P (Dover’s Powder).

Co. B.P., ’14. Plumbi c. Opio, B.P. Plumbi c Opio, B.P.C.

c. Opio, B.P.C. (Ung. Gallae Co.). Emp. Opii, B.P. ’98 with other plasters of the British Pharmacopoeia 1932, and of the British Pharmaceutical Codex. Lin. Opii, B.P. ’14 with other liniments of the British Pharmacopoeia 1932, and of the British Pharmaceutical Codex. Pulv. Ipecac. Co., B.P. ’14 and of Pulv. Ipecac. et Opii, B.P. with any of following: Hydrarg. c. Cret., B.P. Acetysalicylic Acid. Phenacetin. Quinine and its Salts. Sodium Bicarbonate

Mixtures of Ung. Gallae c. Opio, B.P.C. (Ung. Gallae Co.) with other plasters of the British Pharmacopoeia 1914 and 1932, and Pharmaceutical Codex. Mixtures of Lin. Opii Ammon., B.P.C. ’23 with other liniments Pharmacopoeia 1914 and 1932, and of the British Pharmaceutical

Added by: FIFTH SCHEDULE L.N. 64 of 1986. Amended by: (Rule 8) L.N. 33 of 1989; L.N. 426 of 2012. DEPARTMENT OF HEALTH

DRUGS (CONTROL) REGULATIONS AND DANGEROUS DRUGS (INTERNAL CONTROL) CONTROL CARD FOR NARCOTIC/PSYCHOTROPIC DRUGS Name and Surname of Patient .................................... Address ................................................ Legally valid identification document number (where ............................................................. available, or Passport No., in case of non-Maltese citizens who do not hold a legally valid identification document): ................................................

Date of Issue of Card .......... Valid till ........................ ............................................................. Superintendent of

(Columns 1 - 4 to be filled by Prescriber) (Columns 5 - 8 to be filled by Dispensing

Signature of Name of Medical

Date of Drug. Amount Practitioner Amount Date of Signature

Prescription Form and Prescribed and Medical Dispensed Dispensing Apothecary

Dose Council Reg. No. SIXTH SCHEDULE Added by: L.N. 64 of 1986. (Rule 8)

(CONTROL) REGULATIONS AND DANGEROUS DRUGS (INTERNAL CONTROL) RULES

REQUEST FOR THE ISSUE/RENEWAL OF A CONTROL CARD FOR NARCOTIC AND PSYCHOTROPIC DRUGS

of Public Health request that Mr/Ms ................................... aged .............

............................... residing at .................................... .......................................................................................................

issued with a control card for narcotic/psychotropic drugs (§) the control card for narcotic/psychotropic drugs renewed.(§)

whatever is inapplicable.

Medical Practitioner ................................................... Address of Practitioner ........................................................... ........................................................... ...........................................................

........................................................... Medical Council Reg. No. ............................................... .......................................

non-Maltese citizens not holding an I.D. Card, the Passport No., is to be inserted; in the minor the particulars inserted are to be in relation to the I. D. Card or passport of the father, guardian.