Declaration of Use Form.

A Declaration of Use must be completed by the Athlete for Glucocorticosteroids administered by intraarticular, periarticular, peritendinous, epidural, intradermal and inhalation routes, except as noted below and Salmeterol or Salbutamol when administered via inhalation or any other non-systemic route.

Topical Glucocorticosteroid preparations when used for auricular, buccal, dermatological (including  iontophoresis / phonophoresis), gingival, nasal, ophthalmic and perianal disorders are not prohibited and do not require a Therapeutic Use Exemption or a declaration of use.

The 2010 International Standard (current) for Therapeutic Use Exemptions states as follows:


9.0 Declaration of Use

 
9.1   The Prohibited List identifies certain substances and methods that are not prohibited but for which an Athlete is required to file a Declaration of Use. An Athlete should satisfy this requirement by declaring the use on a Doping Control Form and when available by filing a Declaration of Use through ADAMS.

9.2   An Athlete’s failure to declare Use on a Doping Control Form and through ADAMS when available, as stated in Article 9.1, shall not be an anti-doping rule violation.


[Comment to 9.2: The rules of Anti-Doping Organisations with jurisdiction over an Athlete may impose consequences other than an anti-doping rule violation for a failure to declare.]
 


 

*DFSNZ provides access to an equivalent system for certain athletes which is called SIMON.

In order to assist New Zealand Athletes who may not have access to SIMON/ADAMS immediately, we have allowed for this declaration to be made via the form below, by the Physician or the athlete. Please complete the form below and submit to Drug Free Sport NZ. An acknowledgement of receipt of this form will be sent to you.

PLEASE NOTE: To assist the athlete with the information necessary to complete a doping control form, we would also ask that you download the "Athlete Declaration of Use Form" , complete it and give a copy to the athlete.

The Athlete Declaration of Use Form can be faxed to us at 09 5800388 as an alternative to completing the online form below.

Physician Details

Athlete Name:*
Athlete D.O.B.*
Sport:*
Athlete Email:
Athlete Phone:

Administration Details

Physician Name:*
Contact Ph:*
Email:*

Athlete Details

Diagnosis:*
Date of Administration:*
Substance:*
Dose:*
Route of administration:*
Substance:
Dose:
Route of administration:
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