Form 57 - Application process

1. What you need to know

To make an application to the Tribunal for consent to a sterilisation procedure you will need to lodge the following documents:

1. Completed application for consent to special health care in Form 57
2. A statutory declaration containing the following information about the adult:
   1. The family, educational, social and employment background of the adult
   2. Identification of any issues the adult is experiencing with menstruation and/or with sexual activity
   3. What other less intrusive methods than sterilisation have been used or considered to respond to the identified issues
   4. In what way those alternative methods have not been able to be successfully applied to find a practicable response to the identified issues
   5. If the application is made on the basis that the sterilisation is medically necessary, set out the facts and arguments on which the assertion is being made
   6. Why the sterilisation is being sought at this time and whether the procedure can be reasonably postponed
   7. What discussions have ben had with the adult about undergoing a sterilisation procedure and the adult’s response to the procedure
3. A Health Professional Report completed by the adult’s treating health professional or other report which addresses the capacity of the adult to consent to the sterilisation procedure themselves.
4. A medical report from the adult’s treating health professional/s explaining the alternative methods that have been tried in an attempt to manage or achieve cessation of sterilisation or otherwise address the issues for which sterilisation is sought to address and the reasons why those alternative forms of health care were not successful.
5. A medical report completed by the adult’s treating specialist setting out the particulars of the proposed procedure together with information about alternative forms of health care, including other sterilisation procedures, available or likely to become available in the foreseeable future; and the nature and extent of short-term or long-term, significant risks associated with the proposed procedure and available alternative forms of health care, including other sterilisation procedures, the likely long term social and psychological effects of the procedure on the person.
6. A medical report from an independent specialist addressing whether the sterilisation is medically necessary or whether cessation of menstruation by sterilisation is the only practicable way of overcoming problems that the adult has with menstruation.

The Tribunal will usually appoint the Public Guardian as the representative for the adult to represent the adult’s views, wishes and interests in the proceeding. The QCAT Registry will provide the application and any documents filed in support of the application to the adult and the Public Guardian. The QCAT Registry will also give written notice of the application to those who have a close and continuing relationship with the adult.

Provision of the documents outlined above with the application will provide the best chance for the application to be heard and determined as a matter of urgency.  The Tribunal may make directions for the provision of further information, the Tribunal considers is necessary to hear and determine the application. The Tribunal will make a decision following an oral hearing.

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2. Complete and lodge this form:

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