Western Australian Current Acts Western Australian Current Acts (1) An appointment
under section 65(1) must be made in the approved form (the contact person
appointment form ) and include the following —
(a) the
name, date of birth and contact details of the patient;
(b) the
name and contact details of the coordinating practitioner for the patient;
(c) the
name, date of birth and contact details of the contact person;
(d) a
statement that the contact person consents to the appointment;
(e) a
statement that the contact person understands their role under this Act
(including the requirements under section 105 to give the prescribed
substance, or any unused or remaining prescribed substance, to an authorised
disposer and the penalties for offences under that section);
(f) if
the patient was assisted by an interpreter when making the appointment, the
name, contact details and accreditation details of the interpreter;
(g) the
signature of the contact person and the date when the form was signed;
(h) the
signature of the patient, or other person who completes the form on behalf of
the patient, and the date when the form was signed.
(2) If the patient is
unable to complete the contact person appointment form, another person can
complete the form on behalf of the patient if —
(a) the
patient directs the person to complete the contact person appointment form;
and
(b) the
person has reached 18 years of age.
(3) The patient or the
contact person for the patient must give the contact person appointment form
to the coordinating practitioner for the patient.
(4) Within 2 business
days after receiving the contact person appointment form, the coordinating
practitioner for the patient must give a copy of it to the Board.
(5) Subsection (4)
does not apply if a copy of the form is given to the Board under
section 60(1)(b)(ii).
(6) The coordinating
practitioner for the patient cannot prescribe a voluntary assisted dying
substance for the patient before the contact person appointment form is given
to the coordinating practitioner.