from Ontario's Mental Health Act

Form 1 - Application by Physician for Psychiatric Assessment

• MD or Justice of the Peace can complete a Form 1
• This form does not certify a patient
• Criteria:
  1. risk of bodily harm to self;
  2. risk of bodily harm to another;
  3. lack of competence for self-care
• Form 42, a notification of Form 1 administration, MUST be given directly to the pt
• Document in the chart that Form 42 has been given (for medicolegal reasons)
• Valid for 72 h
• Re-assess the pt. after 72 h (i.e., complete another Form 1) if psychiatry has not consulted on the case

Form 3 - Certificate of Involuntary Admission

• This form supersedes a Form 1 in the event that a pt's condition warrants prompt and longer lasting psychiatric attention (i.e., on the basis of the above 3 criteria)
• Valid for 14 d
• Form 30, a notification of Form 3 administration, MUST be given directly to the pt.
• If the pt absconds whilst on a Form 3 a Form 9 will invoke police involvement to return the pt

Form 4 - Certificate of Renewal

• Renews certification after 14 d
• Social worker must be notified so as to serve as a Right's Advisor
• Patient has the right to a Consent and Capacity Board appeal/Hearing
• The Board has the power to deem the pt voluntary in which case institutionalization is not enforceable. This will not occur if risk can be reasonably clarified
• This form can be used secondarily to apply for an “Indefinite Certification” renewal
• Generally granted in 4 week blocks to a maximum of 12 weeks
• At 12 weeks there is an automatic Capacity meeting
• Again, a Form 30 must be given to provide notification of the Form 4
• This indication is clearly for LTC facilities, not HGH 7S

Form 5 - Change to Informal or Voluntary Status

• This form decertifies a pt and is thus given to one who is certified (i.e., Form 4)
• The hospital is considered liable for all the pt's actions (in/out of hospital) if a Form 5 is not completed
• Written notification is not necessary

Form 16

• This form is completed by the Right's Advisor to ask for a Hearing
• The Board consists of 3 members: a lawyer, a psychiatrist not involved in the care of the pt, and a concerned citizen
• Board Hearings are video and audio recorded
• The pt may request the presence of his/her lawyer and should be advised about legal aid

Form 21

• This form is used when financial competency is questioned
• The Public Guardian and Trustee (PGT) must be informed at 905-546-8303 or 1-800-387-2127 on weekends or holidays to speak to Treatment Decisions Consultant (Hamilton office: 1-800-891-0502)
• Inquire as to the appointment of a Substitute Decision Maker (SDM) for finances. If there is no legal appointment (i.e., guardian, POA, representative affirmed by the Consent and Capacity Board) the hierarchy is as follows: spouse or partner, child or custodial parent, non-custodial parent with right of access, sibling, any other relative, PGT
• The SDM must be: capable, willing and available to assume responsibility
• Form 22 (financial statement included) is completed and given to the PGT
• The pt has the right to a Capacity Board Hearing. Form 18 accomplishes this
• At MUMC a psychiatrist must fill out Form 18
• A Form 33 informs pts that they are deemed incapable of managing their estate

Form 23

• Cancels Form 21 (i.e., financial incompetency)

Form 24

• This form extends Form 21 such that the pt's estate can be managed in the community

Links:
Tips for Successful Completion of Form 1's

Evidence Footnotes:
1. reference