Form: Annual Reporting of Custom-made medical devices - Page 1 of 3 - Therapeutic Goods Administration

Annual report

1. What is your name?

(Required)

2. What is your email address?

(Required)

3. What is the name of your organisation?

(Required)

4. What date did you submit your custom-made medical device notification?

Date custom-made medical device notification was submitted (Required)

Day (dd)
-

Month (mm)
-

Year (yyyy)

5. What is the classification of your custom-made medical device?

Device classification (Required)

6. What is the unique custom-made medical device (CMMD) notification identifier/reference number of your previously submitted CMMD notification?

(Your unique CMMD identifier/reference number is a system auto-generated number found at the top of your custom-made device notification form. It will be in the format of CMMD-20XX-XXXXX, CMMD-XXXXXX or custom-made-medical--XXXXX. The identifier/reference number links your annual report to your related CMMD notification)

(Required)

7. How many of these kinds of devices have been supplied in Australia in the last financial year?

(Required)

8. How many of these kinds of devices have been supplied globally in the last financial year?

(Required)

9. Do you supply different models of this kind of device?

(Required) Yes No

If yes, please include the model numbers or identifiers and indicate supply numbers in AU and globally - Example MODEL123 (AU,3) (Global, 41)