This suite of forms has been developed to support the implementation of the Mental Health Act 2014.
Forms will be available to download and print from this page from 1 July 2014.
Assessment order forms
- Assessment order MHA 101 form
- Receipt of person subject to inpatient assessment order MHA 102 form
- Assessment order variation MHA 103 form
- Assessment order extension MHA 104 form
- Assessment order revocation MHA 105 form
- Court assessment order variation MHA 106 form
Temporary treatment order and treatment order forms
- Temporary treatment order MHA 110 form
- Treatment Order or Temporary Treatment Order variation MHA 111 form
- Treatment order or temporary treatment order revocation MHA 112 form
- Treatment order application MHA 113 form
- Mental Health Tribunal application MHA 114 form
Operational forms (leave, transfers, etc)
- Compulsory patient leave of absence MHA 120
- Compulsory patient leave of absence revocation MHA 122 form
- Compulsory patient transfer MHA 123
- Absent without leave patient apprehension MHA 124 form
- Notice of death MHA
Treatment, applications and consent
- Substitute consent to medical treatment by authorised psychiatrist MHA 130 form (revised)
- ECT Informed consent MHA 131 form
- Informed consent to ECT by medical treatment decision maker MHA 131A form
- Electroconvulsive treatment (ECT) application MHA 132 form
- Application for ECT - voluntary adult without capacity to consent MHA 132A
Restrictive interventions
- Restrictive interventions - authority for use MHA 140 form
- Physical restraint urgent approval MHA 141 form
- Restrictive interventions observations MHA 142 form
Security and forensic
- Security or forensic patient receipt MHA 150 form
- Leave of absence security patient MHA 151
- Security patient revocation of leave of absence MHA 153 form
- Forensic patient special leave of absence MHA 154 form
- Security patient application for monitored leave MHA 155 form
- Security or forensic patient transfer MHA 156 form
- Discharge of security patient MHA 157
- Report of psychiatrist MHA 158
- Authorised psychiatrist report MHA 159 form
Cross border
- Transfer patient to interstate mental health facility MHA 170
- Application for transfer to interstate mental health facility MHA 171
Mental Health Tribunal
Access to archived mental health information
- Guide - Access to archived mental health information by health practitioners
- Application Form - Access to archived mental health information by health practitioners
- Consent Form 1 - Individual consent for disclosure of archived mental health information to a health practitioner
- Consent Form 2 - Consent to disclosure of archived mental health information to a health practitioner by the next of kin
Miscellaneous
Reviewed 26 November 2021