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:
Forensic orders and treatment support orders
Persons charged with serious offences
Act Administration
| 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 | Online (DOCX 86 kB) | |
| Notification to the Chief Psychiatrist of non-compliance in the context of COVID-19 | 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 | Not available | Online (PDF 377 kB) |
| 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 ECT | Available from MHRT website | |
Examination authorities
| Application for Examination Authority | Available from MHRT website | |
| Emergency Examination Authority | Available from Public Health Act website | |
| 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 | Not available | Online (PDF 377 kB) |
| 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) | |
| 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 from MHRT website | |
| Written notice of relevant patient's Return | Available from MHRT 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 1075 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) |
Physical restraint
| Physical Restraint - Clinical note | Not available | Online (PDF 671 kB) |
Persons charged with serious offences
| Psychiatrist Report | Print (PDF 133 kB) | Online (PDF 133 kB) |
| Request for Psychiatrist Report | Print (PDF 126 kB) | Online (PDF 578 kB) |
| Chief Psychiatrist Direction for Psychiatrist Report | Not available | Online (PDF 212 kB) |
| 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 NOTE: this form is used by Administrator Delegates only when facilitating the completion of psychiatrist reports. | 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 1075 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 | 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) | |
| 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 from MHRT website | |
Treatment authorities
| Order / Authority Amendment | Print (PDF 32 kB) | Online (PDF 1152 kB) |
| Involuntary Patient and Voluntary High Risk Patient Summary - Clinical note | Not available | Online (PDF 377 kB) |
| 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: 1 June 2017
