Hospital Admission (Forms) Regulations, 1981
Table of Provisions (18)
Statutory Text (18 Articles)
L.N. 90 of 1981
MENTAL HEALTH ACf, 1976
(ACT NO. XVIII OF 1976)
Hospital Admission (Forms) Regulations, 1981
IN exercise of the powers conferred by section 34 of the Mental
Health Act, 1976, hereinafter referred to as "the Act", the Minister of
Health and Environment has made the following regulations
These regulations may be cited
as the Hospital Admission
(Forms) Regulations, 1981.
MENTAL HEALTH ACT,
Application for Admission for Observation (Sections 14 and
16)
( Th is app1i c a ti on is valid o n ly for 14 d a y s beginning with the date appearing on the
medical recommendation last given as the date on which the patient was last
examined by t h e medical practitioner before giving that recommendation.)
TO THE MANAGER OF (1) ...................................
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1. I (2)
of ....................................................................... .
hereby apply for the admission of (3) ..........................
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hospital for observation in accordance with Part III of the
Mental Health Act, 1976.
2. (a)
I am the patient's nearest relative within the
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meaning of the Act, being the patient's (4)
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(4)
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OR
(b)
I have been authorised by the Court to
exercise the functions of the patient's nearest relative under
the Act and a copy (5) of the authority is attached to this
(5)
application.
OR
(c) I am appointed to act as menta I welfare
officer for the purpose of the Act.
(l) The form for ap plication for admission to a hospital for
observation under sections 14 and 16 of the Act shall be the form shown
in the First Schedule to these regulations.
(2) The form for emergency application for admission to a
hospital for observation under sections 15 and 16 of the Act shall be
the form shown in the Second Schedule to these regulations ..
(3) The form for a medical recommendation for admission
to a hosp ital for observation under sections 14, 15 and 17 of the Act
shall be the form shown in the Third Schedule to these regulations.
(4) The form for a joint medical recommendation for ad mis
sion to a hospital for observation under section 14 of the Act shaH be
the form shown in the Fourth Schedule to these regulations.
(5) The form for application by a nearest relative for admis
sion to a hospital for treatment under sections 14 and 16 of the Act
shall be the form shown in the Fifth Schedu!e to these regulations.
(6) The form for application by a mental welfare officer for
admission to a hospita1 for treatment under sections 14 and 16 of the
Act shall be the form shown in the Sixth Schedule to these regulations.
(7) The form for a medical recommendation for admission
to a hospital for treatment under section 14 of the Act shall be the form
shown in the Seventh Schedule to these regulations.
(8) The form for a joint medical recommendation for admis
sion to a hospital for treatment under section 14 of the Act shall be the
form shown in the Eighth Schedule to these regulations.
(9) The form for a report on a hospital in-patient in accord
ance with section 18 of the Act shall be the form shown in the Ninth
Schedule to these regulations.
(10) The form for the renewal of authority for detention in
a hospital in accordance with section 21 (4) of the Act shall be the form
shown in the Tenth Schedule to these regulations.
(11) The form for a report barring the discharge by a nearest
relative in accordance with section 29 of the Act shall be the form
shown in the Eleventh Schedule to these regulations.
B
MENTAL HEALTH ACT, 1976
Emergency Application for Admission for Observation (Sections 15 and 16)
(This application is valid for 2 days beginning with the date appearing on the
medical recommendation as the date on which the patient was last examined by
medical practitioner before giving that recommendation.)
TO THE MANAGER OF ( 1) . .
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I (2) ........................................................
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hereby apply for the admission of (3) .........................
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to the above-named
hospital for observation in accordance with Part III of the
Mental Health Act, 1976.
2. I am a relative of the patient within the
(a)
meaning of the Act, being the patient's (4) .................... .
(4)
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OR
(b) I am appointed to act as a mental welfare
officer for the purposes of the Act.
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3. I last saw the patient on .
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(must not be later than 3 days from date of application)
4. In my opinion it is of urgent necessity for the
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pattent
to be admitted and detained under section 15 of the
Act, and compliance with the requirements of the Act
relating to applications for admission other than emergency
applications would invojve undesirable delay.
5. This application is founded on the medical recom
mendation forwarded herewith.
I last saw the patient on
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(must not be later than 14 days from date of application)
MENTAL HEALTH ACT, 1976
Medical Recommendation for Admission for Observation (Sections 14, 15 and 17)
1. I 0) ....................................................... ..
bein g a
of
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registered medical practitioner, recommend that (2) ........
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.............................. of
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in accordance with Part III of the Mental Health Act, 1976.
2. I last examined the patient on .......................
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19 ......
3. * (a) I was acquainted with the patient previously
to conducting that examination.
*(b) I have been approved by the Minister res
ponsible for Public Health under section 17 of the Act as
having special experience in the diagnosis or treatment of
of mental disorder.
l am of the opinion -
4. (a) that this patient is suffering from mental
disorder of a nature or degree which warrants his/her
detention in a bospital under observation for at Ieast a
limited period,
AND
(b)
that this patient ought to be so detained
(i)
in the interests of the patient's own health
or safety,
(iD
with a view to the protection of other
persons.
5. (This section is to be deleted unless the medical
recommendation is the first recommendation in support of
an emergency application under section 15)
In my opinion it is of urgent necessity for the patient
to be admitted and detained under section 15 of the Act
and compliance with the requirements of the Act relating
to applications for admission for observation other than
emergency application would involve undesirable delay.
Signed ...............................................
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Date
B
Record of Receipt
(This is not part of the recommendation, and is to be completed only if the
medical recommendation is the second recommendation in
support of an
emergency application under section 15)
Insert time and
(3)
This recommendation was received on behalf of the
date.
manager at (3)
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on
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admitted at (3) on
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Signed
on behalf of the manager
Date
SECTION 170) MENTAL HEALTH ACT
This
medical
recommendation shall
not
be
given
by any
of
the
fol1owing
persons
(a)
applicant;
(b) a partner of the applicant or of a practitioner by whom another medical
recommendation is given for the purpose of the same application;
(c) a person employed by the
applicant or
by any
such practitioner
as
aforesaid;
(d) a person who receives or has an interest in the receipt of any payments
made on account of the maintenance of the patient; or
(e)
the husband or wife or a relative by consanguinity or affinity up to the
second degree of the patient, or of any such per son as aforesaid or of a practitioner
by whom another medical recommendation is given for the purpose of the same
application.
FOUR TH SCHEDULE
MENTAL HEALTH ACT, 1976
Joint Medical Recommendation for Admission for Observation (Section 14)
1. We ( 1 ) ....................................................
( l) Names and
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addresses of both
and
of
medical practitioners.
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. ......................................... of
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being registered medical
practitioners recommend that (2) ................................
(2) Name and address
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of patient.
of
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to a hospital for observation in accordance with Part III of
the Mental Health Act, 1976.
2. (a)
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examined this patient on
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*(b)
I was acquainted with the patient previously
to conducting that examination.
I have been approved by the Minister res
*(c)
ponsibie for Public Health under section 17 of the Act as
having special experience in the diagnosis 01' treatment of
mental disorder.
3. I (4) ............................................. last
(a)
. 19 .... .
examined that patient on
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*(b)
I was acquainted with the patient previously
to conducting that examination.
*(c)
I have been approved by the Minister res
ponsible for Public Health under section 17 of the Act as
having special experience in the diagnosis Of treatment of
mental disorder�
4. V/e (5)
and
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.. .. .. .. . . .. .. .. .. .. .. .. .. . .. .. .. .. .. . . .. .... are of the opinion -
that this patient is suffering from menta l
(a)
disorder of a nature or degree which warrants his/her
detention in a hospital under observation for at least a
limited period;
AND
(b)
that this patient ought to be so detained
-
(i)
in the interests of the patient's own health
safety;
Of
with a view to the protection of other
(ii)
persons.
Signed
Date
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Signed ...........
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Date
SECTION 17(3) MENTAL HEALTH ACT
This medical recommendation shall not
be given
by any
of the following
(a)
(b) a partner of the applicant or of a practitioner by whom another medical
recommendation is given f Of the purpose of the same application;
B
(c) a per son employed by the app1icant or by any
such practitioner
as
(d) a person who receives or has an interest in the receipt of any payments
made on account of the maintenance of the patient; or
(e) the husband or wife or a relative by consanguinity or affinity up to the
second degree of the patient, or of any such person as aforesaid 01' of a practitioller
by whom another medical recornmendation is given for the purpose of the sarne
This application is founded on the medical recom
mendation/s forwarded herewith.
MENTAL HEALTH ACT, 1976
Application by Nearest Relative for Admission for Treatment (Sections 14 and 16)
(This application is va1id only for 14 days beginning with the date appearing on the
rnedical recornmendation as the date on which the patient was la st examined by
medical practitioner before giving that recommendation.)
TO THE MANAGER OF ( 1 ) ...................................
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l.
I (2) ........................................................
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of .......................................................................
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hereby apply for the admission of (3) ..........................
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hospital for treatment in accordance with Part III of the
Mental Health Act, 1976 as a patient suffering from
(4)
(a)
I am the patient's nearest relative within the
2. meaning of the Act, being the patient's (5) ....................
(5)
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OR
(b) I have been authorised by the Court/the
patient's nearest relative to exercise the functions of the
patient's nearest re1ative under the Act and a copy of (6) the
authority is attached to th1s application.
I 1ast saw the patient on ........................ 19 ..
3. .
(must not be later than 14 days from date of application)
4. (This section is to be deleted if the patient is
recorded above as suffering from mental illness or severe
su bnormality).
The pa tient's da te of birth is ... .
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5. This application is founded
on
the
medical
recommendations forwarded herewith.
6. (7)
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Signed ...............................................
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Date
Record of Admission
(This is not par t of the a p plicat i on but is to be com p l e t ed later at the h os p it a l)
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(8) . . .
was adrnitted
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(a)
(8)
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... in pursuance of
to (9)
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this app 1 ic a t i o n on ................................. 19 .....
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OR
(b)
(8) ............................................. was
already i n (9)
on the date o f this app 1 i c ati o n and the application was
received by me on behalf of the manager on ................. .
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Signed
on behalf of the manager
Date
(6)
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Signed ............................................... .
Date
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Record of Admission
(This is not part of the application, but is to be completed later at the hospital)
(7) . . . . .. . . . . .. . . . . . . . . . . . . .. . . . . . . . .. . .. was admitted
(a)
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to (8) ............................................. in pursuance of
(8)
this application at ................................. 19 ..... .
OR
(b)
(7) .......................................... was already
an in-patient in (8) .................................................. .
on the date of this application and the application was
received by me on beha1f of the manager on .................
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.................. ; ........... 19 .... .
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Signed ...............................................
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on behalf of the manager
Date
MENTAL HEALTH ACT, 1976
Application by a Mental Welfare Officer for Admisison for Treatment
(Sections 14 and 16)
(This application is valid o n ly for 14 days beg i n ni ng with the date appearing on the
medical recommendation as the date on which the patient was last examined by
medical practitioner before giving that recommendation.)
TO THE MANAGER OF (l) ................................... .
B
I (2)
l.
of
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hereby apply for the admission of (3) .. .
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hospital for treatment in accordance with Part III of the
Mental Hea!-vh Act, 1976 as a patient suffering from
(4) ..............................................................
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2. (a) (This section should be deleted if no consul
tation has taken place).
I ha ve consulted ............................................
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of ........... .. ........................................... who to the
best of my knowledge and belief is the patient's nearest
relative within the meaning of the Act.
OR
l have consulted ..................................
(b)
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of ...................................................... who has been
authorised by the Court to exercise the functions of the
patient's nearest relative under the Act.
OR
I have consulted ................................... .
(c)
of .... . ................................................ who has been
authorised by ................................................ who to
the best of my knowledge and belief is the patient's nearest
relative within the meaning of the Act, to exercise the
functions of the patient's nearest relative under the Act.
AND
she/he has not notified me that she/he objects to this appli
cation being made.
3. (This section should be deleted if consultation has
taken place).
(a) I have been unable to ascertain who is the
patient's nearest relative within the meaning of the Act.
OR
(b) To the best of my knowledge and belief this
patient has no nearest relative with in the meaning of the
Act.
OR
(c)
In my opinion it is not reasonably praeti
c a ble! would inv01ve unreasonable delay before making this
app l iea t ion to eonsu1t
of
who to the best of my knowledge and belief is this patient's
nearest relative within the meaning of the Act/authorised
to exercise the funetions of this p . at ient s nearest relative
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under the Act.
4. I 1ast saw the patient on ........................ 19 .,.
(must be not later than 14 days from date of app1ieation).
5. (This section is to be deleted if the patient is
recorded above as suffering from menta1 il1ness or severe
subnorma1ity.)
The p a tient s date of birth is ........................ 19 ...
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6. This app1ication is founded on the medica1 recom
mendations forwarded herewith.
(5)
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Signed ............................................... .
Date
Record of Admission
(This is not part of the application, but is to be completed later at the hos,pital)
(6)
(6) ................................................... was
(a)
(7)
admitted to (7) ................................. ; ..... in pursuance
of this application at (8) .........................................
(8)
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on
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OR
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was already
(b)
(6)
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an in-patient in (7)
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on the date of this application and the application was
received by me on beha1f of the manager at (8) ..............
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Signed
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on behalf of the manager
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Date
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MENTAL HEALTH ACT, 1976
Medical Recommendation for Admission for Treatment (Section 14)
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I ( l ) ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. of ................. .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. being a registered medical
practitioner recommend that (2) ................................
.
of ...................................................... be admitted
to a hospital for treatment in accordance with Part III of
the Menta] Health Act, 1976.
2. I last examined this patient on ...................... .
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19 ......
I was acquainted with the patient previously
3. *(a)
to conducting that examination.
*(b) I have been approved by the Minister
responsible for Public Health under section 17 of the Act
as having special experience in the diagnosis or treatment
of mental disorder .
4. In
my opinion this patient is suffering from
of a
(3)
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nature or degree which warrants his/her detention in a
hospital for medical treatment within the meaning of the
Act. This opinion is founded on the following grounds:-
(4)
I am of the opinion that it is necessary -
5. (i)
in the interests of this patient's health or
safety,
for the protection of other persons,
(ii)
that this patient should be detained in a hospital, and my
(5)
reasons for this option are:- (5)
Signed
Date
SECTION
17(3) MENTAL HEALTH ACT
recommendation shall
not
be given
by any of
the
following
(a)
(b) a partner of the applicant or of a practitioner by whom another medical
recommendation is given for the purpose of the same application;
(c) a person employed by the
applicant
by any such practitioner
as
01'
(d) a person who receives or has an interest in the receipt of any payments
made on account of the maintenance of the patient; or
(e)
the husband or wife or a relative by consanguinity or affinity up to the
second degree of the patient, or of any such person as aforesaid or of a practitioner
by whom another medical recommendation is given for the purpose of the same
(5)
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Signed ...............................................
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Date
Record of Admission
(This is not p a rt of the a p pl i catio n but is to be completed later at the hospital)
,
(6) ................................................... was
(a)
(7)
admitted to (7)
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pursuanee of this app1ication on ................................
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19 ......
OR
(6)
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(b)
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was
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a1ready in (7)
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of this application, and the applieation was received by me
on behalf of the manager on .......................... 19 .....
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Si g n e d
on behalf of the manager
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Date
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B
MENTAlL HEALTH ACT, 1976
Joint Medical Recommcn.datio!1 for Admission for Treatment (Section 14)
L
We
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(l)
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. ............................................ of .......................
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. .. . .. . .. . .. .. . . . . .. . . , bein g registered medical practi-
tioners, recommend that (2) ......................................
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of
. . .... .............................. ...... be admitted to
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a hospital for treatment in accordance with Part III of the
Mental Health Act, 1976.
2. I (3)
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1ast examined
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rhis patient on ................................. 19 .... .
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* 1 was acquainted with the patient previously to
conducting that examination.
* I have
been approved by the Minister respon
sible for Public Health under section 17 of the Act as
having special experience in the diagnosis 01' treatment of
mental disorder.
3. l (4) . .
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last examined
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this patient on ................................. 19
* I was acquainted with the patient previously to
conc\ucting that examination.
* I have been approved
by the Minister respon
sib1e for Public Health under section 17 of the Act as
having special experience in the diagnosis Of treatment of
mental disorder.
B
4. We (5)
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. ............................................ are of the opinion that
this patient is suffering from (6) ................................
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....................................... of a nature or degree which
warrants his/her detention in a hospital for medical treat
ment within the meaning of the Act. This opinion is
founded on the following grounds:-
5. We are of the opinion that it is necessary -
(i) in the interests of this patient's health and
safety;
(ii) for the protection of other persons,
that he/she should be detained in hospital, and our reasons
Jor this opinion are:- (8)
Signed ...............................................
.
Date
Signed ...............................................
.
D at e
SECTION 17(3) MENTAL HEALTH ACT
This medical recommendation
shall
not be given
by any
of the
following
(a)
(b) a partner of the applicant or of a practitioner by whom another medical
recommendation is given for the purpose of the same applicatjon;
(c) a person employed
by the applicant or by any such practitioner as
(d) a person who receives 01' has an interest in the receipt of any payments
made on account of the maintenance of the patient; or
(e) the husband or wife or a relative by consanguinity or affinity up to the
second degree of the patient, or of any such person as aforesaid or of a practitioner
by whom another medical recommendation is given for the purpose of the same
MENTAL HEALTH ACT, 1976
Report on Hospital Iu·Patient (Section 18)
TO THE MANAGER OF ( l ) ............................
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I (2) .......................................... am the medical
practitioner in charge of the treatment of (3) .
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(3)
....................................... , who is an in-patient in this
hospital and not at present liable to be detained u nde r the
Mental Health Act, 1976. I hereby report for the purposes
of section 18 of the Act, that it appears to me that an
application ought to be made for this patient s admission
'
to hosp i t a l under Part III of the Act for observation or for
treatment.
Signed
Date
To be completed on behalf of the manager
This report was received by me on beha lf of the
manager on ....................................... 19 .....
.
Signed
on behalf of the manager
MENTAL HEAI_TH ACT, 1976
Renewal of Authority for Detention in a Hospital (Section 21 (4)
TO THE MANAGER OF (l) ............................. .
l examined (2) ...........................................
1. (2)
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and hereby report
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that I am of the opinion that this patient is s uffe r i ng from
that
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it is necessary
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in the interests of the patient's health and
(i)
safety;
(ii) for the pro t ec t ion of other persons that the
pat ient should continue to be liable to be detained
under the Mental Health Act, 1976 beyond (4) ........
(4)
.
........................ 19
2. The reasons why t h i s patient cannot suitably
remain in hospital informally or be discharged from
hos pi t a l are
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Responsible Medical Officer
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36l
(The fol1owing is not part of the renewal, but is to be
compJeted on behalf of the manager of the hospita]).
This report was received by me on behaH of the
manager on .................................... 1 9 . ...
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Signed
Date
This report has been considered by the mallager/per
sons authorised to act on behalf of the manager who have
decided to order/not to order that the patient be discharged.
(5) The p at i ent has been informed of the receipt of this
(5)
report.
Signed
on beha1f of the manager
Date
MENTAL HEALTH ACT, 1976
Report Barring Discharge by Nearest Relative (Section 29)
TO THE MANAGER OF (l)
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I her e b y report, for the purposes of section 29 of the
Menta! Health Act, 1976 that I am of the opinion that
(2)
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be likely to act in a manner dangerous to other persons or
to himseJf/herself.
5igned
Responsible Medical Officer
Date
To be completed on behalf of the manager.
This
report was re c e ive d by me on behalf of the
manager at (3)
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(3)
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B
The patient's nearest relative, whose notice of inten
tioll to order
the
patient's discharge
was received at
on
was
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informed of this report on
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Signed
on behalf of the manager
Date
Ippubblikat mit·Taqsima tat·Tagħrif -- Ka.tilja
Kastilja
Publisked by Ihe Information DiYislon
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tal·Gvern
Ihe c.a.s.
fl·U.C.I>-.
Mitbugħ
Stltmperija
Prinled al
Gortrnmel1l Printil1g Pnss
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Priee JOe
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