Mental Health Act forms | Ministry of Health NZ

The Director of Mental Health requires the use of the Mental Health Act forms below, under Section 133A of the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the Mental Health Act).

Forms

Word format

These forms can be filled out electronically.

Transport plan template 28 Oct 2022

( docx, 383.29 KB )

Leave of absence for patient subject to s11 or s13

( docx, 49.12 KB )

Section 8A. Application for assessment 16.11.2021

( docx, 52.61 KB )

Section 8B. Certificate supporting an application for assessment

( docx, 61.82 KB )

Updated 31 January 2024

Notice to attend an assessment examination. Section 9

( docx, 52.05 KB )

Updated 1 November 2021

Certificate of preliminary assessment. Section 10

( docx, 62.24 KB )

Updated 1 November 2021

Clinical Report for Director of Area Mental Health Services

( docx, 64.13 KB )

Updated 1 November 2021

Notice requiring patient to undergo a 5 day further period of assessment and treatment. Section 11

( docx, 49.31 KB )

Updated 1 November 2021

Notice to patient subject to a community treatment order directing change to inpatient status under section 29(3)(a) or re-assessment under section 29(3)(b)

( docx, 53.12 KB )

Section 29 Order

( docx, 262.4 KB )

Section 29 Extension Order 6 months

( docx, 262.89 KB )

Section 29 Extension Order 12 months

( docx, 262.7 KB )

Section 30 Order

( docx, 262.73 KB )

Section 30 extension Order 6 months

( docx, 262.8 KB )

Section 30 extension Order 12 months

( docx, 262.84 KB )

Section 34. Application for extension of compulsory treatment order

( docx, 254.74 KB )

Updated 27 October 2023, effective 29 October 2023

Section 34. Application for extension of compulsory treatment order – Printable version

( docx, 254.74 KB )

Updated 24 October 2023, effective 29 October 2023

Application for assessment of person detained in a penal institution. Section 45

( docx, 51.75 KB )

Updated 1 November 2021

Transfer of detained person. Section 46

( docx, 62.69 KB )

Section 79(7) Certificate of Tribunal Review

( docx, 59.24 KB )

Updated 29 November 2021

Reportable event notification form

( docx, 112.12 KB )

Updated 17 May 2023

Section 113A: Warrant to enter premises where person or proposed patient or patient is

( docx, 33.73 KB )

Section 113A: Warrant to apprehend proposed patient or patient

( docx, 35.71 KB )

PDF format

These forms can be printed and filled out manually.

Transport plan template 28 Oct 2022

( pdf, 227.11 KB )

Leave of absence for patient subject to s11 or s13

( pdf, 167.32 KB )

Section 8A Application for assessment 16.11.2021

( pdf, 195.49 KB )

Section 8B. Certificate supporting an application for assessment

( pdf, 180.85 KB )

Updated 15 March 2024

Notice to attend an assessment examination. Section 9

( pdf, 200.65 KB )

Updated 1 November 2021

Certificate of preliminary assessment. Section 10

( pdf, 192.65 KB )

Updated 1 November 2021

Clinical Report for Director of Area Mental Health Services

( pdf, 224.98 KB )

Updated 1 November 2021

Notice requiring patient to undergo a 5 day further period of assessment and treatment. Section 11

( pdf, 142.27 KB )

Updated 1 November 2021

Leave of absence for a patient subject to a section 11 or section 13 assessment notice Section 11(5)(b) or 13(5)(b)

( pdf, 122.77 KB )

Notice to patient subject to a section 11 or section 13 assessment notice directing change from outpatient to inpatient status. Section 11(3), 13(3)

( pdf, 32.02 KB )

Notice to patient subject to a section 11 or section 13 assessment notice directing change from inpatient to outpatient status. Section 11(4), 13(4)

( pdf, 32.05 KB )

Certificate of further assessment. Section 12

( pdf, 153.12 KB )

Notice requiring patient to undergo a 14 day further period of assessment and treatment. Section 13

( pdf, 33.82 KB )

Certificate of final assessment. Section 14

( pdf, 302.31 KB )

Application for compulsory treatment order. Section 14(4)

( pdf, 22.3 KB )

Report form for Second Health Professional. Section 16(4)

( pdf, 119.84 KB )

Notice to patient subject to a community treatment order directing change to inpatient status under section 29(3)(a) or re-assessment under section 29(3)(b)

( pdf, 649.1 KB )

Leave of absence for inpatient. Section 31

( pdf, 31.3 KB )

Notice of cancellation of leave. Section 31(4)

( pdf, 29.5 KB )

Section 34. Application for extension of compulsory treatment order

( pdf, 222.51 KB )

Application for assessment of person detained in a penal institution. Section 45

( pdf, 170.26 KB )

Updated 1 November 2021

Transfer of detained person. Section 46

( pdf, 197.24 KB )

Application for leave to Director of Mental Health, Ministry of Health. Section 52

( pdf, 132.71 KB )

Referral for second opinion under section 59(2)(b)

( pdf, 18.33 KB )

Section 59(2)(b) second opinion. Section 59

( pdf, 16.03 KB )

Certificate of clinical review of condition of patient subject to compulsory treatment order. Section 76(3)

( pdf, 82.93 KB )

Certificate of clinical review of condition of patient found to be unfit to stand trial and detained as special patient. Section 77(3)

( pdf, 84.49 KB )

Certificate of clinical review of condition of special patient acquitted on account of insanity and detained as special patient. Section 77(4)

( pdf, 112.24 KB )

Certificate of clinical review of condition of restricted patient. Section 78(3)

( pdf, 90.06 KB )

Section 79(7) Certificate of Tribunal Review

( pdf, 194.64 KB )

Updated 29 November 2021

Certificate of Tribunal Review of condition of special patient found to be unfit to stand trial and detained pursuant to order made under Section 24(2)(A) of the Criminal Procedure (Mentally Impaired Persons) Act 2003

( pdf, 96.87 KB )

Certificate of Tribunal Review of condition of special patient acquitted on account of insanity and detained pursuant to order made under Section 24(2)(A), Criminal Procedure (Mentally Impaired Persons) Act 2003

( pdf, 98.24 KB )

Section 113A: Warrant to enter premises where person or proposed patient or patient is

( pdf, 159.3 KB )

Section 113A: Warrant to apprehend proposed patient or patient

( pdf, 165.69 KB )

Patient’s consent form under S34D of the Mental Health Act

This consent form is available on the Ministry of Justice website.

© Ministry of Health – Manatū Hauora