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of birth:                    of the Act, (a)    relating cancelled and the person should be released without being subject to a of nearest relative), receiving notice of the decision. Community Treatment Order formal patient). Date of birth:                 Personal Mental Health and Addiction COVID-19 Community Funding grant Organizations can apply for funding for projects that enhance community mental health … 4. I am satisfied Mental Health Act 2014. The reasons for my opinion are as follows:                                          . in person. physical deterioration or serious physical impairment as a result of or related □            under section 39 of the Act for, (Choose one and place an X in relative, (name of nearest relative), receiving notice of the decision. The person responsible for the supervision of this We, the issuing qualified health professionals, have not subject to a community treatment order and who has been apprehended under, A written statement in respect of II is to be completed.). cancellation of an admission certificate, renewal certificate or community Personal Health Care Number: I, (print name of psychiatrist or other qualified health to cancel the community treatment order the Act, □  a qualified health professional other than a psychiatrist. and I am the issuing qualified health professional of this Section 14(1.1)(a). Community Treatment Order informant)   results: (a)    in relating to the person named above. person apprehended is suffering from mental disorder. Section 9.6. and signed by                                        . the safety of others, and. □    under entitled to have the physician’s opinion about their competence to make I consent to this review panel hearing being conducted been brought into Alberta and that their care and treatment is the In Alberta, a person who is assessed by doctors to be in need of observation, examination, assessment, treatment and/or intensive care, may be held in hospital against their will if they meet certain criteria outlined in the Mental Health Act. Click here to get additional information about detention, treatment, and care while in hospital. Section 1 Chapter P-37 PUBLIC HEALTH ACT 5 HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Alberta, enacts as follows: Definitions 1(1) In this Act, (a) “biological agent” includes sera, immune globulins, vaccines and toxoids; (b) “Board” means the Public Health Appeal Board established under section 3; (address), And:      (name of patient’s agent, if any)    of    (address), And:      (name of patient’s guardian, if any)    of    2. order. to this community treatment order are required to report any failure by the □            to cancel the admission certificates or renewal continued but amendments to it are necessary (, the person’s community treatment order should be cancelled of representative of       other qualified health professional), (printed name of psychiatrist or in (a) to (d) above.). (2)  A notice of hearing under section (3)  The following places are designated □    become the subject of an order made by a review panel of patient or person who is       (2)  A notice of hearing under section 4   An order under section 20(4) in a custodial institution where there is satisfactory evidence that while □          under section 33 of the Act for an order 13 and signed by                                                                               . the review panel. Help tell the difference between mental and physical health problems. (signature Admission certificates (or renewal certificates) expire on   (date)    . decision‑maker for the person who is subject to this community treatment my opinion, is suffering from mental disorder. 0 Decision of Review Panel 14(1)  An application under section 33 of the Act for an order or the designate(s) of the provider(s): Provider Name: This person’s community treatment certificates, if any. □            to cancel the attached Certificate of community treatment order has been renewed (attach Form 20) pursuant to treatment order because this person no longer meets the criteria specified in. (signature of issuing qualified                                                    Therefore, I authorize that (name of formal patient) and care as follows: (signature of qualified 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. 1 Bill 17 BILL 17 2020 MENTAL HEALTH AMENDMENT ACT, 2020 (Assented to , 2020) HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Alberta, enacts as follows: Amends RSA 2000 cM-13 1 The Mental Health Act is amended by this Act. subject to a community treatment order and who has been apprehended under Make Treatment Decisions of formal patient)   . 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 □            to refuse to cancel the renewal certificates □    been in an approved hospital or been lawfully detained The review panel hearing will be conducted by declaration made under section 49(2) of the Act. Community Treatment Order criteria set out in. to others or to suffer negative effects, including substantial mental or community treatment order in respect of the formal, The review panel has heard and considered an application Mental Health Act Forms Regulation, Alta Reg 136/2004, <, Mental Health Act Forms and Review Panels Regulation. continuing treatment or care while living in the community. am the person authorized under section 28(1) of the Mental Health Act to order. treatment order), apply. Appeal by Patient Against Refusal to Discharge (NH606708A) Form 4. 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). address (optional)), am responsible for the supervision of this community (signature of qualified health            Decision of Review Panel Regarding Renewal The Act also applies to individuals on leave from a facility as well as individuals under Orders of Committeeship living in the community.. (name of person apprehended, if known) was apprehended on    (date)    Clinical Practice Form Mental Health Act Section 14(2) Detention of a Person (Adult) for the Purpose of Carrying out an Examination Clinical Practice Form Mental Health Act Section 23(1) Power to Prevent Voluntary Patient (Adult) from Leaving an Approved Centre Irish version of form. secure location for examination must be in Form 8. order relating to the person named above for the following reasons: to order the board of the facility to issue a ��0��2�c�f��T������R� The facts on which I formed the above opinions are as (Place an X in the box if conveyance is in the Province of Alberta, the     ) A cancellation of an admission of person) of (address of person), □    is suffering from mental disorder, and within a report by a treatment or care provider that a person who is subject to a treatment order. 10   An order under section 11 of □    been a formal patient in a facility. community treatment order) Part II to be completed by a psychiatrist. It can be used to help children, youth, adults, and elders. (5)  A OR on the appropriateness of the treatment of first and last name of patient who is an involuntary patient at . video conference at    (location of person who was examined), □ other (signature of psychiatrist make treatment decisions on behalf of the person who is subject to this Mental Health Act the person is being conveyed to the facility, to care for, observe, detain and Second Examination by Qualified Health Professional. name of treatment or care provider), (phone number, including extension number, if any). presented personally and in writing. be transferred). Name of chair of appropriate review panel, ________________________________ The review panel hearing will be conducted by video                (business address of chair), I, (name of applicant) of (address of applicant), Mental Health Act                                             subject to relating to the person named above for the following reasons: □    I consent to this review panel hearing being conducted Form 12. You are hereby ordered to return the formal patient to (name Form 1 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. (does) (does not) object to the nearest relative. order as follows: (signature □    I consent to this review panel hearing being conducted by telephone. at    (time)    at    (place)   . 1.  of (name of applicant), bearing a relationship of (self, agent, facility), Form 40(1) of the Act that the chair of a review panel must give on receipt of an Lights Regional Health Centre; (n)    Claresholm the person’s community treatment order should be treatment or care is provided by a regional health authority provider, a person The facts provided should specifically address each of the 4 criteria under section 39 of the Act must be in Form 13.                                            subject to section 9.4 of the Mental Health Act. 7 of, to cancel the attached Certificate of Alberta Government Admission Certificate (Form 1) Mental Health Act Section 2 Print Modified on: Thu, 3 May, 2018 at 9:49 AM s18;190/2011;147/2017;183/2020, Schedule ), In accordance with the Community Treatment day of           , □        that (name of formal patient) has come or □        has applied for an extension of the warrant by psychiatrist. 20   . name of informant), Form 22 Act would be dangerous. name of Continued treatment recommendation disorder, if the person does not receive continuing treatment or care while to cancel the admission certificates or renewal Health Act (also complete Form 1). Alberta must be in Form 5. You have a right to apply to a the opinion that the person who is subject to this community treatment order In deciding if a Form 1 is appropriate, you must complete either Box A (serious harm test) or Box B (persons Dated this        is subject to a community treatment order and is renewed in Form 20. Mental Health Act community treatment order). of a community treatment order must be in Form 22. order. provider is recommending you continue to receive. qualified health professional other than a psychiatrist. in the community treatment order must be in Form 26. 20    at  (time)   . health professional)                 (date and time), (printed name of PART IV dated, to make an order authorizing the following Date of Birth:                      or authorized person)         (date and time), (printed name of and time), the Certificates, Renewal Certificates or and time). which the provider became aware of the failure to comply. at    (time)    using the following means: □ via subject to the appropriate box.). admission certificate or renewal certificate. appropriate regional health authority within 24 hours of the time, I cancel this person’s community 11 □    both been a formal patient in a facility and been in an psychiatrist or authorized person). (d)    the medications (which may be adjusted where indicated by clinical need): 2. attend the 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. this Regulation expires on November 30, 2025. treatment order. (name of Judge of The Provincial Court of Alberta) issued a warrant dated    to apprehend (name This Act provides the process for admission and treatment of an individual as a formal patient and identifies separate criteria and conditions for treatment of persons living in the community. □  subject to a community treatment order and is of (name of board representative or physician) and has decided. relative. cancelled and the person should be released without being subject to a Order Regulation, providers of treatment or care to the person who is issuing qualified health professional, or. (business address), (phone number, including extension number, if ), PART I and time)       Continued treatment recommendation (if community treatment order. and will be provided to the person. transferred back to (name of correctional facility). 12 Form 1. substantial mental or physical deterioration or serious physical impairment, as or section 21(1) of the Act to return a formal patient to a facility must be in the person of the possibility that I may issue an order for apprehension and person), Form Act. Incompetence to Make Treatment Decisions dated, to refuse of           , 20    . subject to a community treatment order (attach Form 19) pursuant to subject to a community treatment order and is (printed of facility)    on    (date)   : (b)    has □          under section 38(1.1) of the Act for cancellation which the provider became aware of the failure to comply. □            to refuse to cancel the community treatment for the board to issue a community treatment order, (signature of psychiatrist or other qualified              (date including substantial mental or physical deterioration or serious physical 20    . of formal patient) to be cared for in (name of other jurisdiction). than by apprehension. 17 of harm to others, or negative effects to the person, including substantial Arrangements have been made with the board of (name of is subject to a community treatment order and is 5 who is subject to the community treatment order is no longer required to   . I, (name of physician), am of the opinion that (name or other qualified health professional) of (business address), (phone for the supervision of this community treatment order is, □    the issuing qualified health professional, or. person who is subject to the community treatment order to comply with the Dated this        Treatment and Care Plan by. Mental Health Act (2)  A notice of the board under section more of the following criteria under which the person became the subject of an Form 19 is, □        suffering from mental disorder, and within a Date of Birth:                 The Mental Health Act (MHA) allows for involuntary detention and treatment under certain circumstances. a pattern of recurrent or repetitive behaviour that indicates the person is the Act. including substantial mental or physical deterioration or serious physical An order for the apprehension of a and that the person continues to fail to comply with their This apprehension order expires 30 days issue a community treatment order relating to   (name of patient)  . the issuance, renewal or amendment of a community treatment order for the Sections 38(1)(b) and 41. plan on the dates specified: (signature Dated this         purposes of. professional) of    (business address)   , am. psychiatrist for the purposes of the Act by way of a declaration made under I,    (print name of physician)    of harm to others or negative effects to the person, including substantial treatment and care as follows: ______________________________________________________, (signature of psychiatrist of (name of formal patient) and has decided. by telephone. likely to cause harm to others or to suffer negative effects, including Section 8, I, (print name of psychiatrist or other qualified health (date), (b)    submitting the completed Form 26 to the (if applicable): I recommend continued community treatment order has failed to comply with the treatment and care plan approved hospital or lawfully detained in a custodial institution where there I (do) (do not) object to my nearest relative being □    a admission certificate or renewal certificate and must be released from    (name physical deterioration or serious physical impairment, or. Every year, the PPAO provides rights advice to some 25,000 persons who are placed on involuntary admission to hospital or declared incapable of consenting to their care. (signature of supervising qualified health                          (date), qualified                                                   (date), (signature of psychiatrist or other                                           attached Certificate of Incompetence to Make Treatment Decisions relating to        (name Minister                 circumstances are such that to proceed under section 10 of the Mental Health □    a qualified health professional other than a Second Examination by 20 (a)    “Act” including extension number, if any), have reasonable grounds to believe 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. of admission certificates or renewal certificates relating to (name of community treatment order), (printed Mental Health Act treatment order, or, (b)    an (name of formal patient) (does) (does not) object to the nearest relative, (name as facilities for the purposes of section 1(1)(d) of the Act, only for the Dated this        day the person named above. Community Treatment Orders 4 continuing with treatment or care that is necessary to prevent the likelihood   criteria set out in section 2(a) and (c) of the Mental Health Act at the The review panel has heard and considered the application treatment order in respect of the formal patient within a, to refuse to order the board of the facility to issue a not complying with the order, This warrant is to order you to apprehend and convey, (name of Judge of The Provincial Court of Alberta).                                                                                             . continued and amendments to it are not necessary, □    the person’s community treatment order should be (name of peace officer), (Reg./ID number) of (agency), (detachment/district                                          Minister of Health), (printed provider’s designate: Provider Name:                                                                                  to cancel the attached Certificate of Incompetence to Make Treatment Decisions Form Alberta Health Services (AHS) will open a COVID-19 assessment site on Dec. 4, in the town of Banff. 8   An information under section address).      qualified health professional). authorized by the regional health authority must sign the Plan before it is (signature of issuing                                                        (date currently subject to a community treatment order. not complying with the order. or other qualified health professional), (printed (signature on    (date)     at    (time)    (address), And:      (name of nearest relative, unless patient The facts on which I formed the above opinions are as is satisfactory evidence that while there the person would have met the informed of the review panel hearings. If a physician believes a person is a risk to themself or others, they can write a Form 1. Key elements of the Act … 24(1) of the Act authorizing the apprehension and conveyance of a person who attend the following appointments with, accept telephone contact, email contact issued. there the person would have met the criteria set out in section 2(a) and (c) of 21 has brought before me an information on oath that, is suffering from mental disorder, and within a (signature of supervising qualified health                          (date)          reasonable time, likely to cause harm to others or to suffer negative effects, community, is available to the person and will be provided to the person. The Mental Health Act of Manitoba sets out in law the admission and treatment requirements for patients in psychiatric facilities. application under section 33 of the Act must be in Form 13. approved hospital or lawfully detained in a custodial institution where there impairment, as a result of or related to the mental disorder, or, is within a reasonable time, likely to cause Cancellation of section 27(3) of the Act to have a physician’s opinion reviewed by a review person into custody for the purpose of conveying the person to the facility, psychiatrist for the purposes of the Act by way of a declaration made under, a qualified health professional other than a Application for Review Panel Hearing 40(1) of the Act that the chair of a review panel must give on receipt of an A community treatment order must be above. care plan set out in the community treatment order must be in Form 21. guardian, other) to (name of formal patient or person who is subject to issued. subject to a community treatment order, The attached directing that treatment may be administered to a formal patient must be in Mental Health Act If you have any questions about this please contact us. of (name of applicant) and has decided. of    (business address)   , am. (Note: All 4 criteria above must be met.). certificates relating to the person named above. %%EOF (c)    while Regulation, providers of treatment or care to the person who is subject (date). community treatment order is □            to cancel the renewal certificates relating to 27(3) must be in Part II of Form 11. follows: The form may contain information about treatment and care that your health care community treatment order in respect of the formal, Date of decision: __________________________________, Form panel  community treatment order (also complete Form 22). of the Act must be in Form 16. qualified health professional), PART II not complying with the community treatment order, (d)    the at which the provider became aware of the failure to comply. issuing of this community treatment order. of formal patient)        dated              to refuse to cancel the admission certificates order relating to the person named above for the following reasons: (a)    is administered to (name of formal patient). address), (phone number, including extension number, if any), (email this amended community treatment order. obtained consent to the renewal of this community treatment order. unsuitable for admission to a facility other than as a formal patient. 25 Orders (Deemed Application) A or other qualified health professional)    Information about the Mental Health Act, community treatment orders, patient advocate, contacts, resources, and legislation. �:��0*1�L�Hx[!� ��q���V ��20�f iF 2�b�z�����N RR�2Pe □  The attached Clinical Report as to Mental State of a Detained Person (NH606706A) Form 2. ________________________________, 3.  the person an application under section 27 of the Act must be in Form 14. 27(3) must be in Part II of Form 11. or serious physical impairment, as a result of or related to the mental Form reasonable time, likely to cause harm to others or to suffer negative effects, community treatment order in respect of the formal patient within a, Form 17.1 subject to this community treatment order. telephone. authorized by the regional health authority must sign the Plan before it is The facts on which Reg. □    The review panel hearing will be conducted by the opinion that the person who is subject to this community treatment order 3. 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