Cremation Amendment Regulations 2008 (WA)
4 April 2008 GOVERNMENT GAZETTE, WA 1299
Regulations 2008.
CC301*
Cremation Act 1929
Cremation Amendment Regulations 2008
Made by the Governor in Executive Council.
1. Citation
These regulations are the Cremation Amendment
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2. Commencement
These regulations come into operation on 1 July 2008.
3. The regulations amended
The amendments in these regulations are to the Cremation
Regulations 1954.4. Appendix A amended
Appendix A is amended by deleting Forms 6 and 7 and inserting instead -
44
Form 6
Cremation Act 1929
Application for Permit to Cremate Form 6 Applicant Name
AddressDeceased Name
Address
Date of birth / / Male/Female Marital status
OccupationNearest Nearest surviving relative* urviving (if known) Name
elative is Relationship
xplainedat the ndof this form.)
Usual doctor
Name
Address
Doctor(s) who attended deceased during his or her last illness
Name
Address
Instructions Did the deceased leave any written directions about how his or from
her remains were to be dealt with? deceased 0 No Yes. Give details
Objections Do you know of anyone who objects to the deceased's
remains being cremated?No
O Yes. Give detail of that person: Name
Relationship to deceased
Address
Coroner Has the Coroner conducted an investigation or inquest into
the deceased's death?
0 Yes 0 No 0 Unsure
4 April 2008 GOVERNMENT GAZETTE, WA 1301
Applicant's U Administrator of the deceased relationship U
Nearest surviving relative* of the deceased to deceased U Other (*Nearest
surviving If you are not the Administrator, why are you making the relative is
explained at the application instead of the Administrator?__________________ end of this
form.)Details of
Date / /20 Time a.m./p.m. death Place where deceased died
U HomeAddress
U Hospital Address
U Other Address
Do you know, or have reason to suspect, that the deceased's death was directly or indirectly due to any of the following?
(tick fyes)
U violence U poison U privation or neglect U medical procedure U drowning U suffocation U bums
Do you have any reason to suppose that an examination of the
deceased's remains may be desirable?U No
U Yes. Give details
Other Have you, or anyone else that you know of, previously applied applications for a permit to cremate the deceased's remains? U No
U Yes. Give details of previous application Made by
Date / /20 Medical Referee to whom it was made
Statutory I sincerely declare that the information given in this declaration application is true and correct and that I have not omitted any relevant information. I know that it is an offence to make a declaration knowing that it is false in a material particular. Signature
Date / /20 (Witness must be a person Witness authorised to Signature take statutory Name declarations.) Address
Medical - Permit No. referee
Date / /20 (For office use Medical Referee
only) Signature
Name
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The nearest surviving relative of a deceased person, is the first person who is
available from the following persons in the order of priority listed -
(a) a person who, immediately before the death, was living as -(i) the spouse of the deceased; or
(ii) a de facto partner of the deceased and who is at least 18 years of age;
(b) a person who, immediately before the death, was the spouse of the
deceased;
(c) a son or daughter of the deceased who is at least 18 years of age;
(d) a parent of the deceased;(e) a brother or sister of the deceased who is at least 18 years of age.
Form 7
Cremation Act 1929
Certificate of Medical Practitioner ~ Form 7 Certificate to be completed by doctor who attended deceased prior to death.
Add additional pages if more space is required.Attach copies of all relevant laboratory reports, results, certificates etc.
Deceased Name Address
Date of birth / / Age Marital status Male/Female Occupation
Doctor Name Address Are you a spouse, de facto partner or relative of the deceased? 0 No
U Yes Nature of relationship As far as you are aware, do you have a pecuniary interest in
the deceased's estate or any other pecuniary interest in the
deceased's death?
U No
U Yes Give details Were you the deceased's usual doctor?
I] No DYes Recent care During the 4 weeks prior to death did the deceased receive of deceased medical or nursing care?
I No
I Yes Where was the deceased cared for?
o Hospital O Nursing home
O HomeO Other
If cared for at home or other place, who provided care?
U Professional health care providers U Relatives, friends, others
Give names and relationship to the deceased
4 April 2008 GOVERNMENT GAZETTE, WA 1303 Did you attend the deceased during his or her last illness?
U No U Yes Since what date? / /20 Did any other doctor(s) attend the deceased during his or her
last illness?U No
U Yes Give names
Last illness Brief clinical history of last illness including diagnoses and
events leading to death.Details of death
Date / /20 Time a.m./p.m. Place where the deceased died -
O HomeAddress
U Hospital Address
o Other Address
Were you present when the deceased died?
U Yes
U No When did you last see the deceased alive?
Date / /20 Time am/p.m.
Did you examine the deceased's body after death?
U No
U Yes Give details Do you have any reason to suppose that a further examination
of the deceased's remains may be desirable?U No
U Yes Give details
Cause Was a post mortem performed? of death C No
C Yes Give details of results
(* If a Medical *Did you sign the Medical Certificate of Cause of Death? Certificate of
Cause of Death U Yes
0 No Name of the doctor who signed the certificate is attached. answers are not required to these questions.) *Direct cause of death *Antecedent causes of death (if any)
*Conditions contributing to or accelerating death (if any)
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Clinical Do you know, or have reason to suspect, that the deceased's obserNations death was directly or indirectly due to any of the
following? (tick if yes)
_ violence _ poison _ privation or neglect _ medical procedure
drowning_
_ suffocation
_ _ burns In view of the deceased's lifestyle and health, do you have any doubts about the character of the deceased's illness or cause of death?
_ No _ Yes Give details
Safety of At the time of death was the deceased fitted with a cardiac Cremation pacemaker?
_ No
_ _ Yes Has it been removed 0 Yes 0 No Had the deceased received any of the following radioactive treatments?
• Strontium-89 injection (e.g. for bone metastases) during the 12 months prior to death
0 No 0 Yes*
• Iodine-125 seed implant (e.g. for prostate cancer) during the 12 months prior to death
0 No 0 Yes*
• Samarium-153 during the 2 weeks prior to death
0 No 0 Yes*
• Rhenium-188 during the 2 weeks prior to death
0 No 0 Yes*
• Yttrium-90 during the 2 weeks prior to death
0 No 0 Yes*
* If yes — has the Radiation Safety Officer at the treating
institution certified that cremation is safe?
0 No 0 Yes Attach certificate
Are you aware of anything else that could render cremation unsafe? (e.g. other medical devices, recent treatment etc.)
i No
i yes Give details
Certification I certify that the information set out above is true and of medical correct and that I have not omitted any relevant practitioner information.
Signature
Date / /20
By Command of the Governor,
G. M. PIKE, Clerk of the Executive Council.
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