Anatomy (Forms and Fees) Regulations 1933 (WA)

Western Australia Anatomy Act 1930 Anatomy (Forms and Fees) Regulations 1933 Western Australia Anatomy (Forms and Fees) Regulations 1933 Contents 1. Citation 1 1a. Forms 1 Schedule A Notes Compilation table 13 Western Australia Anatomy Act 1930 Anatomy (Forms and Fees) Regulations 1933

1. Citation These regulations may be cited as the Anatomy (Forms and Fees) Regulations 1933 1. [Regulation 1 inserted: Gazette 12 June 1992 p.2417.]

1a. Forms The forms set out in Schedule A are prescribed as the forms to be used under the Act. [Regulation 1a inserted: Gazette 12 June 1992 p.2417.] [2-3. Deleted: Gazette 22 January 1999 p.213.] Schedule A [Forms A and B deleted] Form B(1) Anatomy Act 1930 To the Principal of the…………………………………… School of Anatomy. It is my wish that my remains after death be anatomically examined at the ………………………………………………….School of Anatomy for the advancement of medical education. My personal particulars are: — Full Name: ……………………………………………………………………….............. Usual Address: …………………………………………………………………............... Date of Birth: ……………………………………………………………………............. Religious Persuasion: ……………………………………………………………............ Name and address of senior next of kin: …………………………………………………………………………………….. Preference as to disposal of remains (burial or cremation): ……………………............... …………………………………………………………………………………… I have/have not made a will. (Give name and address of executor if will made.) Signature: ……………………………………………………... Witness (signature): …………………………………….………. (Address): ……………………………………………………….. Note. — Persons who offer their remains for anatomical examination should inform their senior next of kin of their wishes and ask them to co‑operate with the School of Anatomy. If a will has been made it is important that the executor be informed also. A copy of this statement will be supplied for filing with the will on request. [Form B(1) amended: Gazette 30 June 2003 p. 2592.] Form B(2) Anatomy Act 1930 To the Principal of the …………………………………………………………................ School of Anatomy. In accordance with the wish expressed by the late ………………………………............. ………………………………………of………………………………………….............. who died at ………………………….….on …………………………………….............. I have arranged for his/her body to be delivered to you by ……………………............... …………………………………………………for anatomical examination. Particulars of the deceased person are as follows: — Full Name:………………………………………………………………………............... Usual Address:……………………………………………………………………............ Date of Birth:……………………………………………………………………............... Religious Persuasion:……………………………………………………………............... Preference as to disposal (burial or cremation):………………………………….............. …………………………………………………………………………………….. Name and Address of executor or administrator of estate, if this advice is not completed by the executor or administrator …………………………................................. …………………………………………………………………………………….. …………………………………………………………………………………….. Name and address of senior next of kin:……………......................................................... …………………………………………………………………………………….. …………………………………………………………………………………….. (Signature of Informant):………………………………….... Status of Informant (Executor, Administrator, senior next of kin, etc.):……………………………......... .......................................................................................... Date:…………………………………………....................... Note. — This form, together with a copy of the Death Certificate, should be delivered to the School of Anatomy with the body. If the senior next of kin is available they should be requested to complete and sign the following statement: — I,……………………………….……of ………………………………….............. being the senior next of kin, agree to the anatomical examination of his/her body in accordance with his/her wishes. (Signature):………………………………….. (Relationship):………………………………. (Address):…………………………………… ……………………………………………..... [Form B(2) amended: Gazette 30 June 2003 p. 2592.] Form C Anatomy Act 1930 Notice to the Chief Health Officer of the intended Removal of a Body for the Purpose of Anatomical Dissection. Date……………………….............19………. Sir, I desire to inform you that it is my intention to remove to the…………………................ School of Anatomy the body of…………………, an inmate of………………................, who died here on………………………………, at the hour of………………….............. Religious Persuasion of Deceased……………………......Sex………........Age……….... During life * he/she has never expressed to me, nor, so far as I know, to any other person, a wish that * his/her remains should not be submitted to anatomical examination. I certify that the death in this case was not caused by an infectious disease, and that a medical certificate of the cause of death has been given. (Official Designation)………………………….(Signed)………………………............... * Delete word not applicable. [Form C amended: Gazette 10 Jan 2017 p. 246.] Form D Anatomy Act 1930 Notice to the Principal of the……………………………….School of Anatomy. Date………………………………..19……. Sir, I herewith send you, per (a)…………………………the body of………………............... a (b)…………………………..who died on (c)………………………………................at (d)…………………………………..aged (e)………........(f)…………………………...... A certificate signed by a duly qualified medical practitioner and stating the cause of death must be furnished with this form. (Signed)………………….......………. Lawful Custodian of Body. (a) Here state name of conveyor of body. (b) Here state sex. (c) Date of death. (d) Place of death. (e) Age. (f) Religion of Deceased. Form E Anatomy Act 1930 Register No. ……………………………….. ………………………………………School of Anatomy. Date…………………………19………. Received this day, from…………………………the body of……………………............. lately an inmate of…………………………… ………………………………………… Principal Form F Anatomy Act 1930 Register No. ……………………………….. Notice from the Principal of the………………………………………..School of Anatomy to the Chief Health Officer of Receipt of Body for Anatomical Examination. Date…………………………19………. Name of Deceased………………………………………………………………............... Sex……….Age (as far as known)………………..Late abode…………………............... Date of Death……………………………..Place of Death………………………............. Religious Persuasion…………………………… Day and hour of receiving body at School of Anatomy — By whom brought……………………………… To whom delivered……………………………… _________________ I certify that I received with the body the certificate of the cause of death of………..…………………………………………which I herewith enclose. (Signed)…………………………………. [Form F amended: Gazette 10 Jan 2017 p. 246.] Form G Anatomy Act 1930 Register No. ……………………………….. Notice from the Principal of the………………………………………..School of Anatomy to the Chief Health Officer of having returned, for the purpose of sepulture, the remains of persons which have undergone Anatomical Examination. Name of Person whose dissected remains are to be buried. When Received. To whom given for Burial; that is to say, for Conveyance to the Cemetery. Religious Persuasion of Deceased.