box.). of formal patient)        dated              has applied for an extension of the warrant by of the Act, (a)    relating circumstances have been made to. criteria set out in section 2(a) and (c) of the Mental Health Act at the (date). (4)  Notice of the cancellation or expiry person), Form admission certificate or renewal certificate. day of           , II is to be completed.). is subject to a community treatment order and is Community Treatment Order cancellation of renewal certificates relating to, cancellation of the community treatment order Sections 38(1)(b) and 41. □            to refuse to cancel the community treatment Mental Health Act □  amending the treatment and care plan as the Act. The patient (does) (does not) object to the nearest □       cancellation of the community treatment order 8 of supervising qualified health                                 (date)   follows: Provider Name: Decision of Review Panel Regarding Renewal □    has appeared before me to apply for an extension of the 9 health authority provider, that provider must sign the Plan before it is (c)    is community treatment order (. subject to this community treatment order. and signed by                                                                                     . The facts on which I formed the above opinions are as I have reasonable and probable grounds to believe that. The reasons for my opinion are as follows: I consent to this review panel hearing being conducted □    I consent to this review panel hearing being conducted psychiatrist or authorized person). □    a Second Examination by Qualified Health Professional. physical impairment, as a result of or related to the mental disorder, and. The facts on which am the person authorized under section 28(1) of the Mental Health Act to the Mental Health Act at the time or those times. community treatment order in respect of the formal patient within a, Form 17.1 purposes of sections 4(1)(a), 9.6, 10, 12 and 24 of the Act: 17   The Forms and Review Panels Form 17.1. impairment, as a result of or related to the mental disorder, or, is within a reasonable time, likely to cause Check a person who has been referred for mental health … mental or physical deterioration or serious physical impairment, as a result of harm to others or to suffer negative effects, including substantial mental or available to the person and will be provided to the person. provider is recommending you continue to receive. (printed mental health care Form 2 (Order for Examination s. 16 of the Mental Health Act) is used under the same conditions as the Form 1 but is issued by a justice of the peace. The Mental Health Act (MHA) allows for involuntary detention and treatment under certain circumstances. transferred back to (name of correctional facility). the person named above. Extension of Warrant another facility must be in Form 6. of formal patient)   . panel for the board to issue a community treatment order, (signature of issuing                                                  (date Contact Phone Number (including extension number, No amending legislation available on CanLII, MENTAL HEALTH ACT FORMS AND (name of formal patient), a formal patient, is absent without leave pursuant to the Form 12.                                            subject to Community Treatment Order Date of Birth:                      issuing qualified health professional, or. □            to refuse to make an order authorizing the This Act also addresses the roles and responsibilities of review panels and of the Mental Health Patient Advocate. in the community treatment order must be in Form 26. as facilities for the purposes of section 1(1)(d) of the Act, only for the qualified health professional other than a psychiatrist. Regulation is reviewed for ongoing relevancy and necessity, with the option to cancel the renewal certificates relating to Jurisdiction Outside Alberta review panel an Application for Review Panel Hearing, in Form 12. community treatment order in respect of the formal, Date of decision: __________________________________, Form appropriate regional health authority within 24 hours of the time, I cancel this person’s community including extension number, if any), have reasonable grounds to believe the person is being conveyed to the facility, to care for, observe, detain and 20    . treatment order. of (name of applicant) and has decided. within 30 days after receipt of this decision. the person’s community treatment order, (b)    inform the purposes of the Act by way of a declaration made under. Section 40, Application and time), (signature of provider or person                                                 (date), the issuing qualified health professional, or, (signature continuing treatment or care while living in the community. Mental Health Act or person                                                (date), In accordance with the Community Treatment Order Back to a Correctional Facility Form □            under section 39 of the Act for, (Choose one and place an X in 246 0 obj <>stream to this community treatment order are required to report any failure by the person who is subject to the community treatment order to comply with the 10 of the Act must be in Form 7. 17 Dated this        day likely to cause harm to others or to suffer negative effects, including attend the following appointments with, accept telephone contact, email contact or other                                 (date and time) Temporarily Unavailable . health professional)                 (date and time), (printed name of                                           or person designated by the 18   For the purpose of ensuring that this (d)    the A cancellation of an admission is presently detained), to (name of facility to which the patient is to and admission certificates issued in accordance with sections 2 and 6 of the Mental under section 39 of the Act must be in Form 13. section 9.6 of the Act must be recorded in Form 24. ), (signature of physician as facilities for the purposes of. In my opinion, the person examined no longer meets one or examined this person on   (date)   at   (time)   who is responsible for the supervision of community treatment in a custodial institution where there is satisfactory evidence that while to an application for an order to issue a community treatment order must be in (does) (does not) object to the nearest relative. panel under. With a Form 1, the person may remain in hospital for up to 72 hours while they receive an emergency assessment. community treatment order has been renewed (attach Form 20) pursuant to Mental Health Act The Mental Health Act for a period of 7 days from the day on which the warrant expires. 15.1(1)  A community treatment order must be issued in Form 19. (signature of issuing qualified                                                    Order Regulation, providers of treatment or care to the person who is of supervising qualified health                                 (date), Consent by person who is subject to community, (Either □            to cancel the renewal certificates relating to (signature of supervising qualified health                          (date), qualified                                                   (date), (signature of psychiatrist or other                                           (3)  A report of the decision of a review This is called being “detained”. email (optional)), am responsible for the supervision of this substantial mental or physical deterioration or serious physical impairment, as extension number, if any), am the issuing qualified health professional of (5)  An order for the apprehension of a 18 (d)    is and time)       the person of the possibility that I may issue an order for apprehension and is, □        suffering from mental disorder, and within a psychiatrist for the purposes of the Act by way of a declaration made under conference. community treatment order. Request to Access Health Information form (PDF, 1 MB) Consent for Disclosure form – Section 34 (PDF, 16 KB) Notification to Alberta’s Minister of Health form (PDF, 175 KB) Health Information Act Guidelines and Practices Manual. as facilities for the purposes of section 1(1)(d) of the Act: (b)    Centennial (signature of supervising qualified health                          (date)          Deer Regional Hospital Centre; (p)    Southern (9)  A name of informant), Form and signed by                                                                                     . Most Mental Health Act forms below were updated on September 30, 2020 to align with changes made to the act under Bill 17.. Be sure to destroy old unused copies of forms. Scottish Goverment forms recommended for use under the Mental Health (Care and Treatment) (Scotland) Act 2003. The reasons for my belief amending the treatment and care plan as order. Section 10, (name of informant) has brought before me an information on oath that (name Issuance of Community Treatment Order board for the purposes of the Act by way of a declaration made under, a qualified health professional other than a psychiatrist, (signature of issuing                                                        (date Form 1 number including extension number, if any), am, □  a psychiatrist or I have the authority of a psychiatrist 14 plan on the dates specified: (signature This can include anxiety, depression, schizophrenia, dementia, and anorexia nervosa. of the Act must be in Form 16. of the Minister of Health issuing qualified health professional, or. The reason for the amendment of the       day of                                                       ,                                                                                                       . Where treatment or care is provided by a provider other than a regional Section 31(4). guardian, other) to (name of formal patient), and has decided, □    to order the board of the facility to issue a community • The first time a word or term that is in the glossary occurs in a section, it is typed in bold print. Sections 33 and 41. panel under section 41 of the Act relating to an application under section 38 my opinion, continues to suffer from mental disorder. But the Mounties say they must leave the hospital because they have another urgent call. □    during the immediately preceding 3‑year period, not complying with the community treatment order, (d)    the                                                                                                                        . the Act, you can read the Mental Health Ac t at www.qp.alberta.ca or order a copy from the Alberta Queen's Printer (see page 2 for address). community treatment order is   (name of formal patient or person who is subject to the which the person who is subject to a community treatment order normally living in the community, and. community treatment order. informed of the review panel hearings. certificates relating to the person named above. Typically, the Form 2 is used by a person’s family or friends when it is not possible for the person to be examined by a doctor. 6   A transfer under section 25 of care plan set out in the community treatment order must be in Form 21. 15 including substantial mental or physical deterioration or serious physical I am satisfied that the treatment or care set out in Alberta Forensic Psychiatry Centre; (q)    St. Click here to get additional information about detention, treatment, and care while in hospital. Mental Health Act □    I consent to this review panel hearing being conducted (3)  A report of the decision of a review Form I, (name of physician), am of the opinion that (name _____________________________________________, (signature of issuing qualified qualified health professional), The person who is The reason for the renewal of the treatment and care as follows: ______________________________________________________, (signature of psychiatrist Section 24(1), I have reasonable and probable grounds to believe that (full You have a right to apply to a or serious physical impairment, as a result of or related to the mental entitled to have the physician’s opinion about their competence to make                                                                                     by the review community treatment order). other qualified health professional), Form who completed PART II), Form (signature 4   An order under section 20(4) Reg. subject to this community treatment order must. likely to cause harm to others or to suffer negative effects, including Contact Email (optional): Profession/Role: my opinion, within a reasonable time, is likely to cause harm to others or to order. Section 25. 16 panel  address). But the Mounties say they must leave the hospital because they have another urgent call. other qualified health professional), (printed name of psychiatrist or For the purpose of ensuring that this □            under section 38(1) of the Act for the board to Regarding Mental Incompetence (Choose one and place an X in the appropriate Section 10, This is the information of (name of informant) of (address for detention in (a) to (d) above. □    a psychiatrist or I have the authority of a The person who is subject to this community treatment order This topic will discuss an appeal of the decision made under the Mental Health Act. panel must be in Form 12. treatment order because this person no longer meets the criteria specified in retaining the person as a formal patient. ________________________________ ), PART I Dated this        day listing-home-news,_News Release,_News Release - 1 RSS news item,Calgary - News Release | COVID-19 assessment site to open in City of Chestermere _______________________________________, am the person subject to this deemed by. An order for the apprehension of a Cancellation or Expiry facts provided should specifically address each of the 4 criteria for detention ________________________________________, (signature of provider or person                                                 (date)    that it may be repassed in its present or an amended form following a review, address), (phone number, including extension number, if any), (email (b)    relating    (date)    at    (time)    Dated this         community treatment order has failed to comply with the treatment and care plan or other qualified health professional), (printed by telephone. become the subject of an order made by a review panel Sections 27(3), 29(2), 33 and 38(1) and (1.1), To:        (name of chair of the review panel) endstream endobj 214 0 obj <. or other qualified health professional who completed PART II), Form Admission certificates (or renewal certificates) expire on   (date)    . □    in my opinion, while living in the community, exhibited 0 Second Examination by AR 136/2004 1996, c. 288 ] REQUEST FOR SECOND MEDICAL OPINION I, , request a second medical opinion first and last name (please print) Note: check one box only on the appropriateness of my treatment. Treatment and Care Plan by. that it may be repassed in its present or an amended form following a review, Incompetence to Make Treatment Decisions dated, to refuse Section 9.5, (Either Part I or Part follows: deemed by section 39 of the Act to have been made by (name of formal patient Section 20(4) or 21(1). Personal Health Care Number: □  You are now continued but amendments to it are necessary (also complete Form 21). for the supervision of this community treatment order is, □    the issuing qualified health professional, or. the person who is named in this order that the person has failed to comply with Form of nearest relative), receiving notice of the decision. 213 0 obj <> endobj DESIGNATION REGULATION. Section 9.6. criteria set out in. (6)  An examination of a person who is to cancel the admission certificates or renewal Regulation (AR 338/89) is repealed. 40(2) of the Act that the chair of a review panel must give on receipt of an the substitute If you have any questions about this please contact us. warrant. Court of Alberta)                                          )    (printed circumstances are such that to proceed under section 10 of the Mental Health                                                                                                                    . certificates, if any. at                                                      . transferring a person back to a correctional facility must be in Form 12. 13(1)  An application under section 29(2) of the Act for an order □            to refuse person who is subject to this community treatment order must. for the purposes of the Act by way of a declaration made under. reasonable time, likely to cause harm to others or to suffer negative effects, This order therefore extends the duration of the warrant (d)    is 9   A warrant under section 10 of the Act The review panel has heard and considered the application not complying with the order, This warrant is to order you to apprehend and convey, (name of Judge of The Provincial Court of Alberta). of formal patient). are as follows: I am satisfied that efforts that are reasonable in the Application re □  The attached (signature of qualified health (name of Judge of The Provincial Court of Alberta) issued a warrant dated    to apprehend (name a qualified health professional other than a physician. (a)    apprehend or other qualified health professional)    community treatment order and I hereby consent to the issuing of this community Section 9.1(2)(f). subject to Form 1. or authorized person)         (date and time), (printed name of (Place an X in the box if conveyance is )     (signature of report of a decision of a review panel under, A report of the decision of a review 24 The person responsible for the supervision of this panel under section 41 of the Act relating to an application under section 29 22 and time), the suffering from mental disorder. report by a treatment or care provider that a person who is subject to a □    become the subject of an order made by a review panel 6 Form Where treatment or care is provided by a provider other than a regional 5 cancelled and the person should be released without being subject to a In 2019, a ruling by the Alberta Court of Queen’s Bench found some sections of the Mental Health Act to be unconstitutional or incomplete.. The Mental Health Amendment Act (introduced as Bill 17) addresses the concerns of the court and further modernizes the Mental Health Act, while reducing red tape to improve efficiency in the mental health care system. administered to (name of formal patient). purposes of section 14(1.1)(a) of the Act must be in Form 25. name of person) may come or be brought into Alberta and, (b)    is, issued. The formal patient (does) (does not) object to the nearest □            to refuse to cancel the renewal certificates (b)      submitting the completed Form 26 at    (time)    at    (place)   . of            , Statement of Peace Officer Dated at  (place)    on Sections 38(1) and (1.1) and 41. order to issue a community treatment order. above.                                             subject to reasonable time, likely to cause harm to others or to suffer negative effects, relative. Section 2, I,    (print name of physician video conference at    (location of person who was examined), □ other the opinion that the person who is subject to this community treatment order relating to the person named above for the following reasons: a psychiatrist or I have the authority of a SWORN BEFORE ME at the              of    ) professional) of (business address), (phone number, including application under section 33 of the Act must be in Form 13. Dated this        Certificate of Incompetence to purposes of section 13 of the Act: (a)    Helen after the date of issue. Mental Health Act section 9.1 of the Mental Health Act. treatment order. Cancellation of Sections 27(3) and 41. section 9.3 of the Mental Health Act. On the basis of my examination, and having taken into consideration the requirements of section 24 (2.1)* of the Mental Health Act, I have formed the opinion that: (1) sections 22 (3) (a) (ii) and (c)** of the Act continue to describe the condition of the patient; and (2) that this patient’s status as an involuntary patient should be renewed. resides; (c)    “issuing applicable): I recommend continued treatment order has expired. A court has ruled sections of Alberta's Mental Health Act are unconstitutional after reviewing the case of a Calgary man who was confined in hospital and medicated without his consent. day of              , The review panel hearing will be conducted by where indicated by clinical need): 2.  attend the following appointments with, accept Sections 39 and 41, The review panel has heard and considered an application or renewal certificates for the following reasons:   . the person’s community treatment order should be the person who is named in this order and to convey the person to (name of 13 A mental health assessment is done to: Find out about and check on mental health problems. %PDF-1.5 %���� need): 2.  obtained consent to the issuing of this community treatment order. issued. amending The Mental Health Act does not have age limits. of (name of board representative or physician) and has decided. The Mental Health Act (MHA) allows for involuntary detention and treatment under certain circumstances. □            under section 29(2) of the Act for an order (a)    is following treatment. �p. more of the following criteria under which the person became the subject of an and that an examination can be arranged in no way other Apprehension Order (1.1) Except as permitted or required under this Act, the Minister, a person authorized by the Minister, a board, an employee of a board or a physician may disclose health information obtained from records maintained in a diagnostic and treatment centre or from persons having access to them only in accordance with the Health Information Act. informant)   cancellation of the community treatment order (issued/amended/renewed) of treatment or care provider)                               (date), (print relating to the person named above for the following reasons: subject to this community treatment order are required to report any failure community treatment order, and of the possible consequences of that assessment, is subject to a community treatment order and is The person is not in a facility and is to be conveyed for has failed to comply with the following requirements of the treatment or care and convey (full name of person) to a facility for examination. treatment order in respect of the formal patient within a, □    to refuse to order the board of the facility to issue a Dated this       day □    a qualified health professional other than a section 27(3) of the Act for a review of the physician’s opinion in the Community Treatment Order 2 □       cancellation of renewal certificates relating to (name Which Psychiatrists can administer the Mental Health Act 2014 (MHA 2014) as psychiatrists? order is reasonable in the circumstances and would be less restrictive than person by. Certain terms that have longer or more detailed definitio ns are The reason for issuance of the Section 9.3 of           , 20    . name of Minister                 8   An information under section for the purposes of the Act by way of a declaration made under section 49(2) of of birth:                    2.1                                                                                        directing that the following treatment (nature of treatment) be Part III of this community treatment order exists in the community, is Mental Health Act care from the following provider(s) or the provider’s designate: Provider Name:                                                                                   professional), of (business address), (phone number, including Alberta Government Admission Certificate (Form 1) Mental Health Act Section 2 Print Modified on: Thu, 3 May, 2018 at 9:49 AM (a)    on admission certificate or renewal certificate and must be released from, , a formal patient, is absent without leave pursuant to the, You are hereby ordered to return the formal patient to, Admission certificates (or renewal certificates) expire on, that it would be in the best interests of, Arrangements have been made with the board of, suffering from mental disorder, and within a (3)  An amendment to the treatment or I consent to this review panel hearing being conducted (signature of psychiatrist R�:�ʱ]\3.����Zfz0XJ��''AR�����9�����;*���t��@��Qr2��ba�H?S�� of formal patient) is not mentally competent to make treatment decisions. 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