Health Practitioners Tribunal
Health Practitioners (Professional Standards) Act 1999
REGISTRY: BRISBANE
NUMBER:
<~File No.~>
Registrant:
<~REGISTRANTS NAME~>
Registrant’s Board:
<~BOARD NAME~> BOARD OF QUEENSLAND
<~~Complainant:~>
<~COMPLAINANTS NAME~>
REFERRAL NOTICE
To
The Registrar
Health Practitioners Tribunal
District Court
PO Box 15167
CITY EAST Q 4002
In the conduct of a disciplinary matter relating to the Registrant, <~Registrants
Name~> , **arising out of a complaint by ~, it is the belief of the ~ Board of
Queensland that the matter may provide a ground for suspending or cancelling the
Registrant’s registration.
A statement by the Board about the ground for the disciplinary action and the facts
and circumstances forming the basis for the ground, is attached and marked “A”.
**The matter is being referred to the Tribunal at the election of the Registrant
under section 120(3).
Place: Brisbane
Date: <~Today’s Date~>
Member of / Executive Officer
Board of Queensland
(**delete if not applicable)
Referral Notice
Form HPT-6
Section 126
Board of Queensland
Level 19 Forestry House, 160 Mary Street, Brisbane
Board’s solicitor’s Name:
And firm name:
Solicitors business address:
Dx (if any)
Telephone:
Fax:
ADDRESSES FOR SERVICE OF DOCUMENTS
Registrant:
Board:
Board of Queensland
Level 19 Forestry House
160 Mary Street
GPO Box 2438
BRISBANE Q 4001
**Complainant:
Commissioner:
Health Rights Commission
Level 19 Jetset Centre
288 Edward Street
GPO Box 3089
BRISBANE Q 4001