Opioid Treatment Program Forms

To prescribe under the NSW Opioid Treatment Program (OTP), key forms are required to provide patient entry into treatment, exit from treatment, and to notify changes in dosing points.
Application for Authority to Prescribe Methadone or Buprenorphine under the NSW Opioid Treatment Program
click image to access form
click image to access form

This application form is used to apply for authority to enter a patient into the NSW OTP, and must be completed by the prescriber. Authorisation to prescribe methadone or buprenorphine (including buprenorphine-naloxone) must be granted by the Ministry of Health before a prescription may be issued to commence treatment.

This form should also be used if changing pharmacotherapies that a patient is prescribed (i.e., between methadone and buprenorphine preparations, or vice versa).

Exit from Methadone or Buprenorphine Treatment under the NSW Opioid Treatment Program
click image to access form
click image to access form

Patients must be formally exited from treatment by completing and submitting this form for each patient discharged from treatment.

This form should also be used for a patient that is transferred from the care of one prescriber to another. Unit this form is submitted, the new prescriber will be unable to commence treatment for the patient.

NSW Opioid Treatment Program: Notification of Permanent Change in Dosing Point 
click image to access form
click image to access form

If a NSW OTP patient is permanently changing their dosing point, this form should be used to notify the Ministry of Health, Pharmaceutical Regulatory Unit. 

If the patient is travelling outside of NSW, specific guidance is given by the Ministry of health for interstate transfers or overseas travel for how to clinically manage such circumstances.