Approved form AF2002-175

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 50
(see r 57 (7))
Order directing injured worker to submit himself or herself for examination by medical referee
[Heading as in Application.]
Take Notice, that I have appointed Dr.			, of		              , a medical referee appointed for the Workers Compensation Act 1951, to examine you in accordance with the application in this matter for a reference to a medical referee.
You are required to submit yourself for examination by the referee [add where the worker is in a fit condition to travel], and to attend for that purpose at such time and place as may be fixed by him or her.
Dated:
To					of
Registrar of the Magistrates Court.

Endnotes
1	This form was originally in the Workers Compensation Rules 1938, schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the rules and became a form approved under the rules, rule 89 (see amdt 1.2805, amdt 1.2807).
2	This republication includes amendments made under the Legislation Act 2001, part 11.3 (Editorial changes).

©  Australian Capital Territory 2002