Victorian Numbered Regulations

SEVERE SUBSTANCE DEPENDENCE TREATMENT REGULATIONS 2011 (SR NO 5 OF 2011) - SCHEDULE 1

SCHEDULE 1

Sch. 1

Regulation 5

Severe Substance Dependence Treatment Act 2010
Section 10(2)

Severe Substance Dependence Treatment Regulations 2011

APPLICATION FOR A DETENTION AND TREATMENT ORDER

IN THE MAGISTRATES' COURT

OF VICTORIA AT [ venue ]     Court reference:

TO THE MAGISTRATES' COURT

The applicant applies to the Magistrates' Court for a detention and treatment order to be made in respect to the respondent.

1.     DETAILS OF APPLICANT

    Name:

    Address:

    Telephone number:     Email address:

2.     DETAILS OF RESPONDENT

Name: [ full name of person who the applicant believes should be made subject to a detention and treatment order ]

    Date of birth:     Gender:

    Address:

    Telephone number:

    Signature of the applicant:                     Date: / /

PLEASE NOTE: THE APPLICANT MUST TAKE THIS APPLICATION TO THE MAGISTRATES' COURT NEAREST TO THE PLACE OF RESIDENCE OF THE RESPONDENT TO OBTAIN A DATE AND TIME FOR THE HEARING OF THIS APPLICATION. THE APPLICATION MUST HAVE ATTACHED A RECOMMENDATION FOR THE DETENTION AND TREATMENT OF THE PERSON MADE BY A PRESCRIBED MEDICAL PRACTITIONER THAT IS CURRENT AT THE TIME OF THE APPLICATION.

DETAILS OF THE HEARING [ To be completed by the Court ]

A hearing of this application will be held at [ time ] *a.m./*p.m. on [ date ] at the Magistrates' Court at [ venue ].

Date and time application filed at the Magistrates' Court: / / *a.m./*p.m.

*Delete if not applicable
Sch. 1

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