Medical Practice Regulations 2004

Victorian Legislation Parliamentary Documents i Medical Practice Regulations 2004 S.R. No. 104/2004 TABLE OF PROVISIONS Regulation Page 1. Objective 1 2. Authorising provision 1 3. Revocation 2 4. Definition 2 5. Form of application for registration 2 6. Form of application for endorsement of registration 2 7. The register 2 8. Certificate of registration 3 __________________ SCHEDULES 4 SCHEDULE 1—Application for Registration under the Medical Practice Act 1994 4 SCHEDULE 2—Application for Registration/Renewal of Registration as a Medical Student under the Medical Practice Act 1994 6 SCHEDULE 3—Application for Endorsement of Registration under Section 9B of the Medical Practice Act 1994 8 ═══════════════ ENDNOTES 10 -- 1 of 11 -- Victorian Legislation Parliamentary Documents 1 STATUTORY RULES 2004 S.R. No. 104/2004 Medical Practice Act 1994 Medical Practice Regulations 2004 The Lieutenant-Governor as the Governor's Deputy with the advice of the Executive Council makes the following Regulations: Dated: 3 August 2004 Responsible Minister: BRONWYN PIKE Minister for Health DIANE CASEY Clerk of the Executive Council 1. Objective The objective of these Regulations is to prescribe the following matters for the purposes of the Medical Practice Act 1994— (a) the forms for applications relating to registration and endorsement of registration of medical practitioners; and (b) the forms for applications relating to registration of medical students; and (c) the particulars to be included in the register and certificates of registration. 2. Authorising provision These Regulations are made under section 98 of the Medical Practice Act 1994. -- 2 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 2 3. Revocation The Medical Practice Regulations 1994 1 and the Medical Practice (Amendment) Regulations 20012 are revoked. 4. Definition In these Regulations "the Act" means the Medical Practice Act 1994. 5. Form of application for registration (1) For the purposes of section 5(2)(a) of the Act, the prescribed form is set out in Schedule 1. (2) For the purposes of section 9A(2) of the Act, the prescribed form is set out in Schedule 2. 6. Form of application for endorsement of registration For the purposes of section 9B(6)(a) of the Act, the prescribed form is set out in Schedule 3. 7. The register For the purposes of section 17(3)(c) of the Act, the following information is the prescribed information— (a) the address of the medical practitioner; (b) his or her professional qualifications; (c) the date of his or her initial registration; (d) his or her registration number; (e) details of any cancellation of registration. s. 3 -- 3 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 3 8. Certificate of registration For the purposes of section 18(2)(b) of the Act, the following information is the prescribed information— (a) the name of the person registered; (b) his or her qualifications; (c) the date the certificate was issued. __________________ r. 8 -- 4 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 4 SCHEDULES SCHEDULE 1 Regulation 5(1) Medical Practice Regulations 2004 APPLICATION FOR REGISTRATION UNDER THE MEDICAL PRACTICE ACT 1994 To the Medical Practitioners Board of Victoria I apply for registration under the Medical Practice Act 1994. PERSONAL DETAILS Title and name: (Title) (Given Names) (Family Name) Any other names: (e.g. previous family name) Address: Telephone Number: Date of Birth: PROFESSIONAL QUALIFICATIONS Name of institution where study of medicine and surgery undertaken: Date course commenced: Date course completed: Length of course: Internship completed at: (complete if applicable) Current position: If previously registered as a medical practitioner— (a) date and place of initial registration: (b) date and places of any other registrations: Sch. 1 -- 5 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 5 I enclose— (a) evidence of the qualifications which entitle me to be registered; and (b) the fee of $ Signature of applicant: Date: __________________ Sch. 1 -- 6 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 6 SCHEDULE 2 Regulation 5(2) Medical Practice Regulations 2004 APPLICATION FOR REGISTRATION/RENEWAL OF REGISTRATION* AS A MEDICAL STUDENT UNDER THE MEDICAL PRACTICE ACT 1994 To the Medical Practitioners Board of Victoria I apply for registration/renewal of registration* as a medical student under the Medical Practice Act 1994. SECTION 1—ALL APPLICANTS PERSONAL DETAILS Title: (Mr/Ms/Mrs/Miss/Dr/other) Family Name: Given names: Any other names: (e.g. previous family name) Residential address: Postal address: (if different from residential address) Date of birth: SECTION 2—ALL APPLICANTS PRELIMINARY Is this your first application for registration as a medical student? Yes/No If not, what is your Medical Student Registration Number? SECTION 3—UNIVERSITY STUDENTS ONLY UNIVERSITY DETAILS Name of medical school accredited by the Australian Medical Council where the course of study is undertaken: Name of clinical school where the course of study is being undertaken (if applicable): Sch. 2 -- 7 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 7 Year course commenced: Length of course: Year of course: University student number: SECTION 4—AMC CANDIDATES ONLY AUSTRALIAN MEDICAL COUNCIL EXAMINATIONS AMC Candidate number: Medical qualification: University at which degree obtained: Year: Have you sat the multiple choice questions component of the AMC examinations? Yes/No If you have sat the multiple choice questions component, did you pass? Yes/No Have you sat the clinical component of the AMC examinations? Yes/No If you have sat the clinical component, did you pass? Yes/No Institution at which you are undertaking or completing a course of study for an AMC examination: Name of responsible supervisors: SECTION 5—ALL APPLICANTS Signature of applicant: Date: * Delete if inapplicable. __________________ Sch. 2 -- 8 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 8 SCHEDULE 3 Regulation 6 Medical Practice Regulations 2004 APPLICATION FOR ENDORSEMENT OF REGISTRATION UNDER SECTION 9B OF THE MEDICAL PRACTICE ACT 1994 To the Medical Practitioners Board of Victoria I apply for endorsement of registration under section 9B of the Medical Practice Act 1994— * to be exempt from certain provisions of the Chinese Medicine Registration Act 2000 in order to practise Chinese medicine. * to obtain, have in my possession and to use, sell or supply Schedule 1 poisons within the meaning of the Drugs, Poisons and Controlled Substances Act 1981. * I am a registered medical practitioner under the Medical Practice Act 1994. * I enclose a separate application for registration as a medical practitioner under the Medical Practice Act 1994. PERSONAL DETAILS Title and name: (Title) (Given Names) (Family Name) Any other names: (e.g. previous family name) Address: Telephone number: Date of birth: COURSE OF STUDY OR TRAINING I enclose the details of the course of study or training that I have completed which I submit— * qualifies me to practise Chinese medicine. * qualifies me to obtain and have in my possession and to use, sell or supply Schedule 1 poisons within the meaning of the Drugs, Poisons and Controlled Substances Act 1981. Sch. 3 -- 9 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 9 I enclose the fee of $ Signature of applicant: Date: * Delete if inapplicable. ═══════════════ Sch. 3 -- 10 of 11 -- Victorian Legislation Parliamentary Documents S.R. No. 104/2004 Medical Practice Regulations 2004 10 ENDNOTES 1 Reg. 3: S.R. No. 116/1994. 2 Reg. 3: S.R. No. 139/2001. Endnotes -- 11 of 11 --