Forms: Mental Health Act 2016
Need help with your mental health? Read about getting support for your mental wellbeing.
There are a number of approved forms prescribed under the Mental Health Act 2016, including a range of additional forms approved by the Chief Psychiatrist and associated with Chief Psychiatrist policies.
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Administration of the Act
Application for Internal Review Print
(PDF 133 kB)Online
(PDF 614 kB)Notification of Critical Incidents (Private Sector Authorised Mental Health Services) Print
(PDF 147 kB)Online
(PDF 1132 kB)Notification to the Chief Psychiatrist of Significant Non-Compliance with the Act Not available Online
(DOCX 78 kB)Notification to the Chief Psychiatrist of non-compliance in the context of COVID-19 Not available Online
(PDF 293 kB) -
Assessment
Recommendation for Assessment Print
(PDF 172 kB)Online
(PDF 1441 kB)Revocation of Recommendation for Assessment Print
(PDF 115 kB)Online
(PDF 923 kB) -
Classified patients
Recommendation for Assessment Print
(PDF 172 kB)Online
(PDF 1441 kB)Involuntary Patient and Voluntary High Risk Patient Summary - Clinical Note Print
(PDF 377 kB)Not available Transfer Recommendation – Classified Patient Print
(PDF 132 kB)Online
(PDF 956 kB)Administrator Consent – Classified Patient Print
(PDF 279 kB)Online
(PDF 1054 kB)Custodian Consent – Classified Patient Print
(PDF 208 kB)Online
(PDF 678 kB)Classified Patient Notice Event Print
(PDF 35 kB)Online
(PDF 1853 kB)Chief Psychiatrist Approval – Temporary Absences and Limited Community Treatment Print
(PDF 141 kB)Online
(PDF 826 kB)Limited Community Treatment Access and Return Print
(PDF 162 kB)Online
(PDF 589 kB)Order / Authority Amendment Print
(PDF 32 kB)Online
(PDF 1152 kB) -
Electroconvulsive therapy
Certificate to perform Emergency Electroconvulsive Therapy Print
(PDF 281 kB)Online
(PDF 1194 kB)Treatment Application for Electroconvulsive Therapy Available on the Mental Health Review Tribunal website -
Examination authorities
Application for Examination Authority Available on the Mental Health Review Tribunal website Emergency Examination Authority Available on the emergency examination authorities page Outcome of Examination Under an Examination Authority Print
(PDF 184 kB)Online
(PDF 1122 kB) -
Forensic orders and treatment support orders
Order / Authority Amendment Print
(PDF 32 kB)Online
(PDF 1152 kB)Chief Psychiatrist Approval – Temporary Absence and Limited Community Treatment Print
(PDF 141 kB)Online
(PDF 826 kB)Involuntary Patient and Voluntary High Risk Patient Summary - Clinical note Print
(PDF 377 kB)Not available Limited Community Treatment Access and Return Print
(PDF 162 kB)Online
(PDF 589 kB) -
Involuntary patient absences
Request for Police Assistance Print
(PDF 242 kB)Not available Authority to Transport Absent Person Print
(PDF 212 kB)Online
(PDF 1456 kB)Revocation of Authority to Transport Absent Person Print
(PDF 149 kB)Online
(PDF 608 kB)Written notice of relevant patient's absence Available on the Mental Health Review Tribunal website Written notice of relevant patient's Return Available on the Mental Health Review Tribunal website Police and Ambulance Intervention Plan - Clinical note Available in CIMHA -
Magistrates Court
Examination Report Print
(PDF 102 kB)Online
(PDF 1127 kB)Examination Order Print
(PDF 128 kB)Online
(PDF 608 kB) -
Mechanical restraint
Reduction and Elimination Plan - Seclusion and Mechanical Restraint Print
(PDF 193 kB)Online
(PDF 1089 kB)Application for Approval to Use Mechanical Restraint Print
(PDF 220 kB)Online
(PDF 1114 kB)Authorisation of Mechanical Restraint Print
(PDF 54 kB)Online
(PDF 1592 kB) -
Mental Health Court
Mental Health Court Update Report Not available Online
(PDF 2187 kB)Reference of a person's mental state to the Mental Health Court Available on the Mental Health Court website Application to withdraw reference Available on the Mental Health Court website -
Physical restraint
Physical Restraint - Clinical note Not available Online
(PDF 671 kB) -
Persons charged with serious offences
Psychiatrist Report Print
(PDF 133 kB)Not available Request for Psychiatrist Report Print
(PDF 126 kB)Online
(PDF 578 kB)Chief Psychiatrist Direction for Psychiatrist Report Print
(PDF 212 kB)Not available Request to Extend Timeframe for Psychiatrist Report Print
(PDF 120 kB)Online
(PDF 812 kB)Notice of Suspension of Proceedings Not available Online
(PDF 242 kB)Proceedings No Longer Suspended Print
(PDF 197 kB)Online
(PDF 660 kB)Notice to Administrator – Person Not Participating in Good Faith Print
(PDF 110 kB)Online
(PDF 838 kB)Advice to Chief Psychiatrist – Public Interest Consideration Print
(PDF 128 kB)Online
(PDF 1058 kB)Request for Prosecuting Authority Brief of Evidence Not available Online
(DOC 99 kB) -
Seclusion
Authorisation of Seclusion Print
(PDF 207 kB)Online
(PDF 981 kB)Extension of Seclusion Print
(PDF 218 kB)Online
(PDF 1002 kB)Reduction and Elimination Plan - Seclusion and Mechanical Restraint Print
(PDF 193 kB)Online
(PDF 1089 kB)Release and Return to Seclusion Print
(PDF 121 kB)Online
(PDF 581 kB)Emergency Authorisation of Seclusion Print
(PDF 137 kB)Online
(PDF 634 kB) -
Temporary absence
Chief Psychiatrist Approval – Temporary Absence and Limited Community Treatment Print
(PDF 141 kB)Online
(PDF 826 kB)Chief Psychiatrist Approval – Approved Absences in relation to COVID-19 Emergency Period for Particular Patients Not available Online
(DOCX 91 kB) -
Transfers and transport
Patient Transfer Print
(PDF 189 kB)Online
(PDF 642 kB)Request for Police Assistance Print
(PDF 242 kB)Not available Application for Warrant for Apprehension of Person Print
(PDF 196 kB)Online
(PDF 647 kB)Warrant for Apprehension of Person Print
(PDF 155 kB)Online
(PDF 609 kB)Form of warrant Print
(PDF 192 kB)Online
(PDF 645 kB)Application for Approval to Use Mechanical Restraint Print
(PDF 220 kB)Online
(PDF 1114 kB)Authorisation of Mechanical Restraint Print
(PDF 54 kB)Online
(PDF 1592 kB)Application to transfer interstate Available on the Mental Health Review Tribunal website -
Treatment authorities
Order / Authority Amendment Print
(PDF 32 kB)Online
(PDF 1152 kB)Involuntary Patient and Voluntary High Risk Patient Summary - Clinical note Print
(PDF 377 kB)Not available Limited Community Treatment Access and Return Print
(PDF 162 kB)Online
(PDF 589 kB)Treatment Authority Print
(PDF 130 kB)Online
(PDF 1013 kB)Revocation of Treatment Authority Print
(PDF 116 kB)Online
(PDF 924 kB) -
Victim information
Application for Information Notice Print
(PDF 164 kB)Online
(PDF 1201 kB)Application for Information Notice - Forensic Disability Client Print
(PDF 27 kB)Online
(PDF 1201 kB)Application for Classified Patient Information Print
(PDF 114 kB)Online
(PDF 1201 kB)
Last updated: 15 October 2021
