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Matters to be certified in administration certificate—Act, s 81 (3) (d)

In force

The following information is prescribed:

(a)

the name and date of birth of the individual;

(b)

the name, business address and telephone number of the administering practitioner;

(c)

the date and time the approved substance was administered to the individual;

(d)

the address of the place where the administering practitioner administered the approved substance to the individual;

(e)

if the administering practitioner was present when the individual died—

(i)

the date and time of the individual’s death; and

(ii)

the time between the substance being administered to the individual and the individual’s death;

(f)

if the administering practitioner was not present when the individual died—

(i)

the estimated time of the individual’s death; and

(ii)

the estimated time between the substance being administered to the individual and the individual’s death;

(g)

details of any complications relating to the administration of the approved substance to the individual;

(h)

the name, date of birth, home address or business address and telephone number of the witness to the administration of the approved substance;

(i)

a statement, endorsed by the administering practitioner’s signature, acknowledging the truth of the information in the administering certificate;

(j)

the day the administering practitioner signed the administration certificate.

Part 4 Requirements for coordinating practitioners, consulting practitioners and administering practitioners

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