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