Section 11 (1) (a) BEFORE amended by BC Reg 89/2021, effective March 22, 2021.
(a) to the Workers Compensation Board for the purposes of section 6.2 of the Workers Compensation Act;
Schedule, under "About the Notice of Intention Form" (parts) BEFORE amended by BC Reg 76/2022, effective March 30, 2022.
The exposed individual named in this notice believes that he or she has been exposed, in one of the circumstances covered by the Emergency Intervention Disclosure Act, to a bodily substance of the source individual named in this notice. In order to determine whether potential exposure to hepatitis B, hepatitis C or HIV has occurred as a result of this bodily substance exposure, the exposed individual is seeking to have the source individual tested for these diseases.
The purpose of the testing order is to provide information to the exposed individual about the health status of the source individual, which may assist the exposed individual and/or his or her physician in managing the consequences of the exposure.
4. By signing this form, the source individual consents to have the test results communicated to the physician of the exposed individual and for that physician to communicate the test results to his/her patient (the exposed individual).
Schedule, in the Physcian's Report Form BEFORE amended by BC Reg 76/2022, effective March 30, 2022.
Physician's Report
(section 7 (b) )
Schedule, Application to Obtain a Testing Order Form BEFORE amended by BC Reg 42/2024, effective March 6, 2024.
APPLICATION TO OBTAIN A TESTING ORDER
(section 7 (a) )
Court File No. ..............................
Court Location ..............................
In the Provincial Court of British Columbia
In the case between:
.....................................................................[name of Applicant].....................................................................
and
.....................................................................[name of Respondent]..................................................................
Filed by:
Name .................................................................................. Date of birth ........................... (APPLICANT)
Address for service....................................................................................................... City ........................
Province .................... Postal Code ................................. Phone ................................... Fax ........................
Notice to:
Name ....................................................................................Date of birth ...................... (RESPONDENT)
Address for service ....................................................................................................... City ........................
Province .................... Postal Code ................................. Phone ................................... Fax ........................
I am applying for a testing order requiring the Respondent named above to have a sample of bodily fluid taken and tested for a pathogen that causes a prescribed disease, as provided for under section 3 of the Emergency Intervention Disclosure Act.
The date and circumstances of the exposure are:
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
[Attach additional sheet if more space required.]
Attached to this application is the physician's report as required under section 3 (3) (a) of the Emergency Intervention Disclosure Act.
| Dated ......[mmm/dd/yyyy]...... | Signature of Applicant.............................................. |
Serving the Application for a Testing Order on the Respondent
Under section 3 (3) (d) of the Emergency Intervention Disclosure Act, the application for a testing order must be served on the source individual (Respondent) at least 4 days before the court hears the application.
| To be completed by the court before this Application is served on the Respondent: Date of Court Hearing: ................................................................................... Time: ................................... a.m./p.m. (or as soon after this time as the court schedule allows) Court Location: ............................................................................................... |