New South Wales Consolidated Acts New South Wales Consolidated Acts(Section 9 (2))
Drug and Alcohol Treatment Act 2007
Part 1
I, [name in full--use block letters [#93] (accredited medical practitioner) of [address [#93] certify that on [date [#93] immediately before, or shortly before, completing this certificate, I personally assessed [name of person in full [#93] under section 9 of the Drug and Alcohol Treatment Act 2007 at [state place where assessment took place [#93] for a period of [state length of assessment [#93].
I certify the following matters--
1. I am of the opinion that--(a) the person I assessed (the dependent person) has a severe substance dependence, and(b) care, treatment or control of the person is necessary to protect the person from serious harm, and(c) the person is likely to benefit from treatment for his or her substance dependence but the person has refused treatment, and(d) no other appropriate and less restrictive means for dealing with the person are reasonably available.
2. The following incidents and/or abnormalities of behaviour have been observed by me and/or communicated to me by others (state name, relationship and address of each informant)--
3. The general medical and/or surgical condition of the dependent person is as follows--
4. The following medication (if any) has been administered for the purposes of treating the dependent person--
5. I am of the opinion the dependent person should be detained for 28* days for treatment under the Drug and Alcohol Treatment Act 2007 .
(* lesser days may be inserted in item 5 by the accredited medical practitioner)
6. I am not a near relative or the primary carer of the dependent person.
Signed thisday of20
Signature
Part 2
A member of staff of the NSW Health Service or a police officer may transport the dependent person to a treatment centre under the Drug and Alcohol Treatment Act 2007 .
If the assistance of a police officer is required, this Part of the Form must be completed.
YOU SHOULD NOT REQUEST THIS ASSISTANCE UNLESS THERE ARE SERIOUS CONCERNS RELATING TO THE SAFETY OF THE DEPENDENT PERSON OR OTHER PERSONS IF THE PERSON IS TAKEN TO A TREATMENT CENTRE WITHOUT THE ASSISTANCE OF A POLICE OFFICER.
I have assessed the risk and I am of the opinion that there are serious concerns relating to the safety of the dependent person or other persons if the dependent person is taken to a treatment centre without the assistance of a police officer. The reason for me being of this opinion is (include any information known about the dependent person relevant to the risk)--
Signed thisday of20
Signature
Notes:1 Section 9 of the Drug and Alcohol Treatment Act 2007 states--9 Assessing persons for detention and treatment(1) A medical practitioner may request an accredited medical practitioner to assess a person for detention and treatment under this Act.(2) After assessing the person, the accredited medical practitioner may issue a certificate (a
"dependency certificate" ), in the form shown in Schedule 2, stating the person may be detained for treatment under this Act for the period stated in the certificate.(3) A dependency certificate may be issued in relation to the person only if the accredited medical practitioner is satisfied--(a) the person has a severe substance dependence, and(b) care, treatment or control of the person is necessary to protect the person from serious harm, and(c) the person is likely to benefit from treatment for his or her substance dependence but has refused treatment, and(d) no other appropriate and less restrictive means for dealing with the person are reasonably available.(4) The accredited medical practitioner may have regard to any serious harm that may occur to--(a) children in the care of the person, or(b) dependants of the person.(5) If a dependency certificate is issued in relation to the person assessed under this section, the person may be detained in accordance with the certificate for treatment under this Act.2 In the Drug and Alcohol Treatment Act 2007
"close friend or relative" is defined as follows--
"close friend or relative" , of a dependent person, means a friend or relative of the person who--(a) maintains both a close personal relationship with the person through frequent personal contact and a personal interest in the person's welfare, and(b) does not provide support to the person wholly or substantially on a commercial basis.3 In the Drug and Alcohol Treatment Act 2007
"primary carer" is defined as follows--
"primary carer" , of a dependent person, means--(a) the guardian of the dependent person, or(b) if the dependent person is not under guardianship, the person nominated by the dependent person as the primary carer under a nomination under section 13 that is in force, or(c) if paragraphs (a) and (b) do not apply--(i) the spouse of the dependent person, if any, if the relationship between the person and the spouse is close and continuing, or(ia) the de facto partner of the dependent person, if any, if the relationship between that de facto partner and the dependent person is close and continuing, or(ii) any person who is primarily responsible for providing support or care to the dependent person (other than wholly or substantially on a commercial basis), or(iii) a close friend or relative of the dependent person.4 In the Drug and Alcohol Treatment Act 2007
"severe substance dependence" is defined as follows--
"severe substance dependence" , in relation to a person, means the person--(a) has a tolerance to a substance, and(b) shows withdrawal symptoms when the person stops using, or reduces the level of use of, the substance, and(c) has lost the capacity to make decisions about his or her substance use and personal welfare due primarily to his or her dependence on the substance.5 Under a dependency certificate the dependent person must not be detained for treatment for more than 28 days from the day the certificate was issued and as soon as practicable after the certificate is issued the person must be brought before a Magistrate for a review of the issuing of the certificate.