Special Access Scheme: NSW/TGA medicinal cannabis forms

New South Wales/Therapeutic Goods Administration

4 July 2018

If you are not prescribing medicinal cannabis for a patient in NSW, please DO NOT use these forms. Please use the regular SAS forms located on the SAS web page.

These Special Access Scheme (SAS) forms are for medical practitioners prescribing for patients in NSW who would like to notify/apply to access and prescribe an unapproved medicinal cannabis product to a patient in NSW.

The below SAS Category A notification (SASA) form and SAS Category B (SASB) application form include both TGA's requirements under the SAS and the requirements for NSW's Health's Application for Authority Application form to Prescriber and Supply a Cannabis Product for Human Therapeutic Use. These forms should be submitted once only to the TGA who will forward to NSW. They do not need to be submitted to NSW Health in addition to TGA.

Once submitted, TGA and NSW Health will simultaneously review the information provided. Decision letter/s will then be emailed to those contact details provided on the form.

How to access a pdf or Word document

These forms are available in pdf and Microsoft Word formats. The pdf form can be filled in and saved to your computer using Adobe Reader version 7 or later or any version of Adobe Acrobat Standard or Professional. If you have an earlier version of Adobe Reader you can fill in the form on-screen and print it out but you will not be able to save the completed form.

Category A

*Please note that for Schedule 8 products the SASA notification form will need to be sent to the TGA prior to supply of the medicinal cannabis product to the patient. While SASA is a notification to TGA, NSW Health approval authorisation is still required for Schedule 8 products before prescribing can lawfully occur.

Category B