sec.59Contact person appointment form

### sec.59 Contact person appointment form An appointment under section 58 (1) must be made in the approved form (the contact person appointment form ). The contact person appointment form must include the following— the name, date of birth and contact details of the person; the name and contact details of the coordinating practitioner for the person; 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 the contact person’s role under this Act (including the requirements under section 63 to give the voluntary assisted dying substance, or any unused or remaining substance, to an authorised disposer and the penalties for offences under that section); if the person was assisted by an interpreter when making the appointment— the name, contact details and accreditation details of the interpreter; and a statement signed by the interpreter certifying that the interpreter provided a true and correct translation of any information translated; the signature of the contact person and the date when the form was signed; the signature of the person, or other person who completes the form on behalf of the person, and the date when the form was signed. At the person’s request, another person (the second person ) may complete the form on the person’s behalf if— the person is unable to complete the form; and the second person is at least 18 years of age; and the second person signs the contact person appointment form in the presence of the person. The person or the contact person for the person must give the contact person appointment form to the coordinating practitioner for the person. Within 2 business days after receiving the contact person appointment form, the coordinating practitioner for the person must give a copy of it to the board. Maximum penalty—100 penalty units. The coordinating practitioner for a person may not prescribe a voluntary assisted dying substance for the person before the contact person appointment form is given to the coordinating practitioner. (sec.59-ssec.1) An appointment under section 58 (1) must be made in the approved form (the contact person appointment form ). (sec.59-ssec.2) The contact person appointment form must include the following— the name, date of birth and contact details of the person; the name and contact details of the coordinating practitioner for the person; 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 the contact person’s role under this Act (including the requirements under section 63 to give the voluntary assisted dying substance, or any unused or remaining substance, to an authorised disposer and the penalties for offences under that section); if the person was assisted by an interpreter when making the appointment— the name, contact details and accreditation details of the interpreter; and a statement signed by the interpreter certifying that the interpreter provided a true and correct translation of any information translated; the signature of the contact person and the date when the form was signed; the signature of the person, or other person who completes the form on behalf of the person, and the date when the form was signed. (sec.59-ssec.3) At the person’s request, another person (the second person ) may complete the form on the person’s behalf if— the person is unable to complete the form; and the second person is at least 18 years of age; and the second person signs the contact person appointment form in the presence of the person. (sec.59-ssec.4) The person or the contact person for the person must give the contact person appointment form to the coordinating practitioner for the person. (sec.59-ssec.5) Within 2 business days after receiving the contact person appointment form, the coordinating practitioner for the person must give a copy of it to the board. Maximum penalty—100 penalty units. (sec.59-ssec.6) The coordinating practitioner for a person may not prescribe a voluntary assisted dying substance for the person before the contact person appointment form is given to the coordinating practitioner. - (a) the name, date of birth and contact details of the person; - (b) the name and contact details of the coordinating practitioner for the person; - (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 the contact person’s role under this Act (including the requirements under section 63 to give the voluntary assisted dying substance, or any unused or remaining substance, to an authorised disposer and the penalties for offences under that section); - (f) if the person was assisted by an interpreter when making the appointment— (i) the name, contact details and accreditation details of the interpreter; and (ii) a statement signed by the interpreter certifying that the interpreter provided a true and correct translation of any information translated; - (i) the name, contact details and accreditation details of the interpreter; and - (ii) a statement signed by the interpreter certifying that the interpreter provided a true and correct translation of any information translated; - (g) the signature of the contact person and the date when the form was signed; - (h) the signature of the person, or other person who completes the form on behalf of the person, and the date when the form was signed. - (i) the name, contact details and accreditation details of the interpreter; and - (ii) a statement signed by the interpreter certifying that the interpreter provided a true and correct translation of any information translated; - (a) the person is unable to complete the form; and - (b) the second person is at least 18 years of age; and - (c) the second person signs the contact person appointment form in the presence of the person.