Voluntary Assisted Dying Act 2019

An appointment under section 65(1) must be made in the approved form (the contact person appointment form) and include the following —

the name, date of birth and contact details of the patient;

the name and contact details of the coordinating practitioner for the patient;

the name, date of birth and contact details of the contact person;

a statement that the contact person consents to the appointment;

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);

if the patient was assisted by an interpreter when making the appointment, the name, contact details and accreditation details of the interpreter;

the signature of the contact person and the date when the form was signed;

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.

If the patient is unable to complete the contact person appointment form, another person can complete the form on behalf of the patient if —

the patient directs the person to complete the contact person appointment form; and

the person has reached 18 years of age.

The patient or the contact person for the patient must give the contact person appointment form to the coordinating practitioner for the patient.

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.

Subsection (4) does not apply if a copy of the form is given to the Board under section 60(1)(b)(ii).

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.