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Forms: Mental Health Act 2016

There are a number of approved forms prescribed under the Mental Health Act 2016 (MHA 2016). In addition, the Chief Psychiatrist has developed a range of additional forms necessary for administration of the MHA 2016.

Any person performing a function under the MHA 2016 must use the relevant form. Forms used under the MHA 2016 are a legislative requirement and as such must be completed as accurately as possible. Errors or omissions may impact on the validity of the form, and in turn the subsequent treatment and/or detention of the patient under the MHA 2016.

The following forms are associated with the published Chief Psychiatrist Practice Guidelines.

All published forms have been approved by the Chief Psychiatrist.

MHA 2016 forms are available in PDF and Online versions:

  • PDF: print and hand write on form
  • Online: complete on screen and print/email (only available for users on the Queensland Health network)

Select one of the following topic areas to view relevant forms below:

Act Administration

Assessment

Classified patients

Electroconvulsive therapy

Examination authorities

Forensic orders and treatment support orders

Involuntary patient absences

Magistrates Court

Mechanical restraint

Physical restraint

Persons charged with serious offences

Seclusion

Temporary absence

Transfers and transport

Treatment authorities

Victim Information


Act Administration

Application for Internal ReviewPrint
(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)

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Assessment

Recommendation for AssessmentPrint
(PDF 172 kB)
Online
(PDF 1441 kB)
Revocation of Recommendation for AssessmentPrint
(PDF 115 kB)
Online
(PDF 923 kB)

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Classified patients

Recommendation for AssessmentPrint
(PDF 172 kB)
Online
(PDF 1441 kB)
Involuntary Patient and Voluntary High Risk Patient Summary - Clinical NoteNot availableOnline
(PDF 377 kB)
Transfer Recommendation – Classified PatientPrint
(PDF 132 kB)
Online
(PDF 956 kB)
Administrator Consent – Classified PatientPrint
(PDF 279 kB)
Online
(PDF 1054 kB)
Custodian Consent – Classified PatientPrint
(PDF 208 kB)
Online
(PDF 678 kB)
Classified Patient Notice EventPrint
(PDF 35 kB)
Online
(PDF 1853 kB)
Chief Psychiatrist Approval – Temporary Absences and Limited Community TreatmentPrint
(PDF 141 kB)
Online
(PDF 826 kB)
Limited Community Treatment Access and ReturnPrint
(PDF 162 kB)
Online
(PDF 589 kB)
Order / Authority AmendmentPrint
(PDF 140 kB)
Online
(PDF 833 kB)

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Electroconvulsive therapy

Certificate to perform Emergency Electroconvulsive TherapyPrint
(PDF 281 kB)
Online
(PDF 1194 kB)
Treatment Application for ECT Available from MHRT website

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Examination authorities

Application for Examination AuthorityAvailable from MHRT website
Emergency Examination AuthorityAvailable from Public Health Act website
Outcome of Examination Under an Examination AuthorityPrint
(PDF 184 kB)
Online
(PDF 1122 kB)

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Forensic Orders and Treatment Support Orders

Order / Authority AmendmentPrint
(PDF 140 kB)
Online
(PDF 833 kB)
Chief Psychiatrist Approval – Temporary Absence and Limited Community TreatmentPrint
(PDF 141 kB)
Online
(PDF 826 kB)
Involuntary Patient and Voluntary High Risk Patient Summary - Clinical noteNot availableOnline
(PDF 377 kB)
Limited Community Treatment Access and ReturnPrint
(PDF 162 kB)
Online
(PDF 589 kB)

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Involuntary patient absences

Request for Police AssistancePrint
(PDF 121 kB)
Online
(PDF 920 kB)
Authority to Transport Absent PersonPrint
(PDF 212 kB)
Online
(PDF 1456 kB)
Revocation of Authority to Transport Absent PersonPrint
(PDF 149 kB)
Online
(PDF 608 kB)
Written notice of relevant patient's absence Available from MHRT website
Written notice of relevant patient's Return Available from MHRT website
Police and Ambulance Intervention Plan - Clinical note Available in CIMHA

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Magistrates Court

Examination ReportPrint
(PDF 102 kB)
Online
(PDF 1127 kB)
Examination OrderPrint
(PDF 128 kB)
Online
(PDF 608 kB)

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Mechanical restraint

Reduction and Elimination Plan - Seclusion and Mechanical RestraintPrint
(PDF 193 kB)
Online
(PDF 1075 kB)
Application for Approval to Use Mechanical RestraintPrint
(PDF 220 kB)
Online
(PDF 1114 kB)
Authorisation of Mechanical RestraintPrint
(PDF 54 kB)
Online
(PDF 1592 kB)

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Physical restraint

Physical Restraint - Clinical note Not availableOnline
(PDF 671 kB)

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Persons charged with serious offences

Psychiatrist ReportPrint
(PDF 144 kB)
Online
(PDF 1133 kB)
Request for Psychiatrist ReportPrint
(PDF 126 kB)
Online
(PDF 578 kB)
Chief Psychiatrist Direction for Psychiatrist ReportNot availableOnline
(PDF 212 kB)
Request to Extend Timeframe for Psychiatrist ReportPrint
(PDF 120 kB)
Online
(PDF 812 kB)
Notice of Suspension of ProceedingsNot availableOnline
(PDF 242 kB)
Proceedings No Longer SuspendedPrint
(PDF 197 kB)
Online
(PDF 660 kB)
Notice to Administrator – Person Not Participating in Good FaithPrint
(PDF 110 kB)
Online
(PDF 838 kB)
Advice to Chief Psychiatrist – Public Interest ConsiderationPrint
(PDF 128 kB)
Online
(PDF 1058 kB)
Request for Prosecuting Authority Brief of Evidence
NOTE: this form is used by Administrator Delegates only when facilitating the completion of psychiatrist reports.
Not availableOnline
(DOC 99 kB)

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Seclusion

Authorisation of SeclusionPrint
(PDF 181 kB)
Online
(PDF 981 kB)
Extension of SeclusionPrint
(PDF 193 kB)
Online
(PDF 1002 kB)
Reduction and Elimination Plan - Seclusion and Mechanical RestraintPrint
(PDF 193 kB)
Online
(PDF 1075 kB)
Release and Return to SeclusionPrint
(PDF 121 kB)
Online
(PDF 581 kB)
Emergency Authorisation of SeclusionPrint
(PDF 137 kB)
Online
(PDF 634 kB)

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Temporary absence

Chief Psychiatrist Approval – Temporary Absence and Limited Community TreatmentPrint
(PDF 141 kB)
Online
(PDF 826 kB)

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Transfers and transport

Patient TransferPrint
(PDF 189 kB)
Online
(PDF 642 kB)
Request for Police AssistancePrint
(PDF 121 kB)
Online
(PDF 920 kB)
Application for Warrant for Apprehension of PersonPrint
(PDF 196 kB)
Online
(PDF 647 kB)
Warrant for Apprehension of PersonPrint
(PDF 155 kB)
Online
(PDF 609 kB)
Form of warrantPrint
(PDF 192 kB)
Online
(PDF 645 kB)
Application for Approval to Use Mechanical RestraintPrint
(PDF 220 kB)
Online
(PDF 1114 kB)
Authorisation of Mechanical RestraintPrint
(PDF 54 kB)
Online
(PDF 1592 kB)
Application to transfer interstateAvailable from MHRT website

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Treatment authorities

Order / Authority AmendmentPrint
(PDF 140 kB)
Online
(PDF 833 kB)
Involuntary Patient and Voluntary High Risk Patient Summary - Clinical noteNot availableOnline
(PDF 377 kB)
Limited Community Treatment Access and ReturnPrint
(PDF 162 kB)
Online
(PDF 589 kB)
Treatment AuthorityPrint
(PDF 130 kB)
Online
(PDF 1013 kB)
Revocation of Treatment AuthorityPrint
(PDF 116 kB)
Online
(PDF 924 kB)

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Victim Information

Application for Information NoticePrint
(PDF 164 kB)
Online
(PDF 1201 kB)
Application for Information Notice - Forensic Disability ClientPrint
(PDF 27 kB)
Online
(PDF 1201 kB)
Application for Classified Patient InformationPrint
(PDF 114 kB)
Online
(PDF 1201 kB)

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Last updated: 1 June 2017

Public Health Act forms

Emergency Examination Authority form

Mental Health Review Tribunal forms

Visit the Mental Health Review Tribunal (MHRT) website to register for access to MHRT forms.

Mental Health Court forms

Visit the Queensland Courts website for access to Mental Health Court forms under the Mental Health Act 2016.

Mental Health Act Liaison Service

Contact a Mental Health Act Liaison Officer for information about the Mental Health Act 2016.

Phone: 3328 9899 or 1800 989 451
Email: MHA2016@health.qld.gov.au