Schedule 1 Form of mandatory testing order

Schedule 1 Form of mandatory testing order

section 4(2)

Mandatory testing order under Mandatory Disease Testing Act 2021

Name of third party

[Name of third party] is required to attend [name and address of place] to provide blood as soon as practicable but no later than 2 business days after being served with this order.

Date of birth of third party

[Date of birth of third party].

Details of blood-borne diseases

The blood of [name of third party] must be tested for—

• *all blood-borne diseases, or

• *[specific blood-borne diseases].

*Delete whichever does not apply

Note—

Blood-borne disease is defined in the Mandatory Disease Testing Act 2021 to mean HIV infection, Hepatitis B, Hepatitis C or other blood-borne disease prescribed by the regulations under that Act.

Details of worker’s medical practitioner

[Name of worker] has authorised the following medical practitioner to receive the third party’s blood test results on the worker’s behalf—

Name of medical practitioner—

Telephone number—

Address—

Email address—

Name of medical practice at which the medical practitioner works—

Telephone number of medical practice—

Address of medical practice—

Email address of medical practice—

Note 1—

More than one medical practitioner at a medical practice can be listed.

Note 2—

Under the Mandatory Disease Testing Act 2021, section 22(1)(a), the third party’s blood test results will be provided to the medical practitioner authorised by the worker to receive the blood test results on the worker’s behalf.

Details of third party’s medical practitioner—if applicable

[Name of third party] has authorised the following medical practitioner to receive the third party’s blood test results on the third party’s behalf—

Name of medical practitioner—

Telephone number—

Address—

Email address—