Mental Health Act forms

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.

Document

download Transport plan template 28 Oct 2022

( docx, 383.29 KB )

Document

download Leave of absence for patient subject to s11 or s13

( docx, 49.12 KB )

Document

download Section 8A. Application for assessment 16.11.2021

( docx, 52.61 KB )

Document

download Section 8B. Certificate supporting an application for assessment

( docx, 61.82 KB )

Caption

Document

download Notice to attend an assessment examination. Section 9

( docx, 52.05 KB )

Caption

Document

download Certificate of preliminary assessment. Section 10

( docx, 62.24 KB )

Caption

Document

download Clinical Report for Director of Area Mental Health Services

( docx, 64.13 KB )

Caption

Document

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

( docx, 49.31 KB )

Caption

Document

download 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 )

Document

download Section 29 Order

( docx, 262.4 KB )

Document

download Section 29 Extension Order 6 months

( docx, 262.89 KB )

Document

download Section 29 Extension Order 12 months

( docx, 262.7 KB )

Document

download Section 30 Order

( docx, 262.73 KB )

Document

download Section 30 extension Order 6 months

( docx, 262.8 KB )

Document

download Section 30 extension Order 12 months

( docx, 262.84 KB )

Document

download Section 34. Application for extension of compulsory treatment order

( docx, 254.74 KB )

Caption

Document

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

( docx, 254.74 KB )

Caption

Document

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

( docx, 51.75 KB )

Caption

Document

download Transfer of detained person. Section 46

( docx, 62.69 KB )

Document

download Section 52 Application for Leave to Director of Mental Health

( docx, 107.34 KB )

Document

download Section 79(7) Certificate of Tribunal Review

( docx, 59.24 KB )

Caption

Document

download Reportable event notification form

( docx, 112.12 KB )

Caption

Document

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

( docx, 33.73 KB )

Document

download Section 113A: Warrant to apprehend proposed patient or patient

( docx, 35.71 KB )

PDF format

These forms can be printed and filled out manually.

Document

download Transport plan template 28 Oct 2022

( pdf, 227.11 KB )

Document

download Leave of absence for patient subject to s11 or s13

( pdf, 167.32 KB )

Document

download Section 8A Application for assessment 16.11.2021

( pdf, 195.49 KB )

Document

download Section 8B. Certificate supporting an application for assessment

( pdf, 180.85 KB )

Caption

Document

download Notice to attend an assessment examination. Section 9

( pdf, 200.65 KB )

Caption

Document

download Certificate of preliminary assessment. Section 10

( pdf, 192.65 KB )

Caption

Document

download Clinical Report for Director of Area Mental Health Services

( pdf, 224.98 KB )

Caption

Document

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

( pdf, 142.27 KB )

Caption

Document

download 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 )

Document

download 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 )

Document

download 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 )

Document

download Certificate of further assessment. Section 12

( pdf, 153.12 KB )

Document

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

( pdf, 33.82 KB )

Document

download Certificate of final assessment. Section 14

( pdf, 302.31 KB )

Document

download Application for compulsory treatment order. Section 14(4)

( pdf, 22.3 KB )

Document

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

( pdf, 119.84 KB )

Document

download 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 )

Document

download Leave of absence for inpatient. Section 31

( pdf, 31.3 KB )

Document

download Notice of cancellation of leave. Section 31(4)

( pdf, 29.5 KB )

Document

download Section 34. Application for extension of compulsory treatment order

( pdf, 222.51 KB )

Document

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

( pdf, 170.26 KB )

Caption

Document

download Transfer of detained person. Section 46

( pdf, 197.24 KB )

Document

download Section 52 Application for Leave to Director of Mental Health

( pdf, 132.71 KB )

Document

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

( pdf, 18.33 KB )

Document

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

( pdf, 16.03 KB )

Document

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

( pdf, 82.93 KB )

Document

download 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 )

Document

download 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 )

Document

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

( pdf, 90.06 KB )

Document

download Section 79(7) Certificate of Tribunal Review

( pdf, 194.64 KB )

Caption

Document

download 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 )

Document

download 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 )

Document

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

( pdf, 159.3 KB )

Document

download 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.