Writable PDF versions of MHA Forms for private services can be found below. These are password protected to ensure that the electronic transfer of data is secure. The password can be obtained by contacting the Office of the Chief Psychiatrist on 6553 0000.
For help on completing the writable Forms, please watch this short instructional video.
Referral for Examination / Detention
Form 1A Referral for examination by a psychiatrist
Form 1A attachment Referral for examination by a psychiatrist attachment
Form 1B Variation of referral
Form 2 Order to detain voluntary inpatient in authorised hospital for assessment
Form 3A Detention order
Form 3B Continuation of detention
Form 3C Continuation of detention to enable a further examination by psychiatrist
Form 3D Order authorising reception and detention in an authorised hospital for further examination
Form 3E Order that a person cannot continue to be detained
Transport / Transfer orders
Form 4A Transport order
Form 4B Extension of transport Order
Form 4C Transfer order
Form 4D Interstate transfer order (Currently unavailable)
Form 4E Approval of interstate transfer order (Currently unavailable)
Community Treatment Orders
Form 5A Community treatment order
Form 5B Continuation of community treatment order
Form 5C Variation of community treatment order
Form 5D Request for practitioner to examine patient
Form 5E Notice and record of breach of CTO
Form 5F Order to attend
Inpatient Treatment Orders
Form 6A Inpatient treatment order
Form 6B Inpatient treatment order in a general hospital
Form 6B attachment Inpatient treatment order in a general hospital – report for the Chief Psychiatrist
Form 6C Continuation of inpatient treatment order
Form 6D Confirmation of inpatient treatment order
Form 7A Grant of leave to an involuntary inpatient
Form 7B Extension and variation of leave
Form 7C Cancellation of leave
Form 7D Apprehension and return order
Form 8A Record of search and seizure
Form 8B Record dealing with seized article
Treatments
Form 9A Record of emergency psychiatric treatment
Form 9B Report to Chief Psychiatrist about provision of urgent non-psychiatric treatment
Restraint
Form 10A Record of oral authorisation of restraint
Form 10B Written bodily restraint order
Form 10C Record of informing medical practitioner and treating psychiatrist of bodily restraint
Form 10D Record of observations made of restrained person
Form 10E Record of examination of restrained person
Form 10F Variation of bodily restraint order
Form 10G Revocation of expiry of bodily restraint order
Form 10H Review of bodily restraint order by psychiatrist
Form 10I Record of post restraint examination
Seclusion
Form 11A Record of oral authorisation of seclusion
Form 11B Written seclusion order
Form 11C Record of information medical practitioner and treating psychiatrist of seclusion order
Form 11D Record of observations made of secluded person
Form 11E Record of examination of secluded person
Form 11F Revocation or expiry of seclusion
Form 11G Record of post seclusion examination
Access to Information
Form 12A Nomination of nominated person (non writable form)
Form 12B Refusal of request to access document
Form 12C Restriction on freedom of communication
Form 12C attachment Restriction on freedom of communication
ECT
Form 13 Statistics about ECT (contact OCP monitoring if required)