On this page
- Assessment Order forms
- Temporary Treatment Order and Treatment Order forms
- Operational forms (leave, transfer etc)
- Treatment, applications and consent
- Restrictive interventions
- Security and forensic patients
- Cross border
- Access to archived mental health information
- Admissions, registration and separations
- Advance statement of preferences
- Nominated support persons
The department has developed the following forms to support the implementation of the Mental Health and Wellbeing Act 2022 (the Act).
Assessment Order forms
MHWA 101 Assessment Order
MHWA 102 Receipt of person subject to Inpatient Assessment Order
MHWA 103 Variation of Assessment Order
MHWA 104 Extension of Assessment Order
MHWA 105 Revocation of Assessment Order
MHWA 106 Variation of Court Assessment Order
Temporary Treatment Order and Treatment Order forms
MHWA 110 Temporary Treatment Order
MHWA 111 Variation of Temporary Treatment Order or Treatment Order
MHWA 112 Revocation of Temporary Treatment Order or Treatment Order
MHWA 113 Application for another Treatment Order
MHWA 114 Application to Mental Health Tribunal
Operational forms (leave, transfer etc)
MHWA 120 Leave of absence for compulsory patient
MHWA 122 Revocation of leave of absence for compulsory patient
MHWA 123 Variation of order to transfer compulsory patient
MHWA 124 Taking care and control of patient absent without leave
MHWA 132A Application for ECT - Voluntary Adult without capacity to consent
Treatment, applications and consent
MHWA 130 Substitute consent to medical treatment by authorised psychiatrist
MHWA 131 Informed consent to ECT
MHWA 131A Informed consent to ECT by medical treatment decision maker
MHWA 132 Application for electroconvulsive treatment (ECT)
MHWA 132A Application for ECT - Voluntary Adult without capacity to consent
Restrictive interventions
MHWA 140 Authority for use of restrictive interventions
MHWA 141 Authority for urgent physical restraint
MHWA 142 Restrictive interventions observations
MHWA 143 Authority for use of chemical restraint
Guidelines regarding the use of chemical restraint are published by the Office of the Chief Psychiatrist.
Security and forensic patients
MHWA 150 Receipt of security or forensic patient
MHWA 151 Leave of absence for security patient
MHWA 153 Revocation of leave of absence for security patient
MHWA 154 Special leave of absence for forensic patient
MHWA 155 Application for monitored leave for security patient
MHWA 156 Transfer of security or forensic patient
MHWA 157 Discharge of security patient
MHWA 158 Report of psychiatrist
MHWA 159 Report of authorised psychiatrist
Cross border
MHWA 170 Interstate transfer of compulsory patient with consent
MHWA 171 Interstate transfer of compulsory patient without consent
Access to archived mental health information
Access to archived mental health information held by the Department of Health can be requested through Freedom of Information or via email at foi@health.vic.gov.au
Admissions, registration and separations
MHWA PR 1 Registration - Demographics
MHWA PR 1a Registration - Legal and clinical
MHWA PR 2 Admission
MHWA PR 5 Separation
Advance statement of preferences
Forms for making or revoking an advance statement of preferences are on the advance statement of preferences page.
Nominated support persons
Forms for nominating a nominated support person or revoking a nomination can be found on the nominated support persons page.
Reviewed 19 September 2023