For the purposes of section 32(3) of the Act, the prescribed form for a certificate is a certificate that contains the following—
(a) a statement by the registered medical practitioner or approved health professional that the taking of the blood sample complies with the requirements of these Regulations;
(b) the name of the person from whom the blood sample was taken;
(c) the date and time the blood sample was taken;
(d) the name and signature of the registered medical practitioner or approved health professional who took the blood sample.