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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 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)

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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)

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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)

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Electroconvulsive therapy

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

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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)

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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)

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Involuntary patient absences

Request for Police Assistance Print
(PDF, 121 kB)
Online
(PDF, 920 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

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Magistrates Court

Examination Report Print
(PDF, 102 kB)
Online
(PDF, 1127 kB)
Examination Order Print
(PDF, 128 kB)
Online
(PDF, 608 kB)

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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)

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Physical restraint

Physical Restraint - Clinical note  Not available Online
(PDF, 671 kB)

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Persons charged with serious offences

Psychiatrist Report Print
(PDF, 144 kB)
Online
(PDF, 1133 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)

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Seclusion

Authorisation of Seclusion Print
(PDF, 181 kB)
Online
(PDF, 981 kB)
Extension of Seclusion Print
(PDF, 193 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)

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Temporary absence

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

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Transfers and transport

Patient Transfer Print
(PDF, 189 kB)
Online
(PDF, 642 kB)
Request for Police Assistance Print
(PDF, 121 kB)
Online
(PDF, 920 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

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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)

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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)

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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: (07) 3328 9899 or 1800 989 451
Email: MHA2016@health.qld.gov.au