Western Australian Current Acts Western Australian Current Acts A referral must be in
the approved form and must —
(a)
include the following —
(i)
the date and time when it is made;
(ii)
the date and time when it will expire;
(iii)
the place where it is made;
(iv)
whether or not it can be extended under section 45 and,
if it can, the process for extending it;
(v)
the place where the examination will be conducted;
(vi)
the date and time when the assessment required by
section 39(1) was completed;
and
(b)
certify that, having regard to the criteria specified in section 25, the
practitioner making it reasonably suspects that the person who is referred is
in need of an involuntary treatment order; and
(c)
include the information on which the suspicion is based; and
(d) in
respect of so much of that information as was obtained during the assessment
by the practitioner making the referral, distinguish between —
(i)
the information obtained from the person who is referred,
including by observing the person and asking the person questions; and
(ii)
the information obtained from another person or from the
person’s medical record;
and
(e)
include the name, qualifications and signature of the practitioner making the
referral.