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This document follows the format of the form approved by the Department of Health and Human Services of Victoria for the Appointment of a Medical Treatment Support Person pursuant to the Medical Treatment Planning and Decisions Act 2016 (VIC).
1️⃣ You (including a child who has decision-making capacity) can appoint one Support Person;
2️⃣ Your Support Person can be an adult or a child;
3️⃣ The role of your Support Person is to support you to make, communicate and act on your Medical Treatment Decisions;
4️⃣ Your Support Person cannot make any Medical Treatment Decisions on your behalf;
5️⃣ Your Support Person has the authority to access, or help you to access, your health information (including your medical records) relevant to your medical treatment;
6️⃣ Any existing Support Person appointment previously made by you under the Act will be revoked on making this appointment;
7️⃣ A competent (preferably NAATI accredited) interpreter can assist to facilitate the preparation +/or witnessing of the appointment.
Your Support Person can also represent your interests in relation to your medical treatment.
For example, you might tell them what you want, or do not want, and they may help you talk to your doctors, nurses, and other health practitioners about this.
They can do this even if you become so unwell that you are not able to make your own decisions at the time.
However, your Support Person does not have power to make medical treatment decisions for you, unless you have appointed them as your Medical Treatment Decision Maker.
You must sign the appointment form in front of two independent adult witnesses (neither witness can be your appointed Support Person):
1️⃣ Someone authorised to witness affidavits; and
2️⃣ A Medical Practitioner (medical doctor).
If you are unable to sign yourself, you can direct someone else to sign in your presence using our alternative appointment form which follows the format of the form approved by the Department of Health and Human Services of Victoria pursuant to the Act for this purpose.
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