Mental Health Act 1983 Statutory Forms

The Department of Health's official pink forms, together with the CQC's Word-format treatment forms (T1-6), are published below with permission from the respective organisations.

The Welsh Assembly Government have produced forms which are available free of charge.

External link

Welsh forms on "HOWIS" website

Admission forms

• Form A1 section 2 - application by nearest relative for admission for assessment
• Form A2 section 2 - application by an approved mental health professional for admission for assessment
• Form A3 section 2 - joint medical recommendation for admission for assessment
• Form A4 section 2 - medical recommendation for admission for assessment
• Form A5 section 3 - application by nearest relative for admission for treatment
• Form A6 section 3 - application by an approved mental health professional for admission for treatment
• Form A7 section 3 - joint medical recommendation for admission for treatment
• Form A8 section 3 - medical recommendation for admission for treatment
• Form A9 section 4 - emergency application by nearest relative for admission for assessment
• Form A10 section 4 - emergency application by an approved mental health professional for admission for assessment
• Form A11 section 4 - medical recommendation for emergency admission for assessment

Hospital forms

• Form H1 section 5(2) - report on hospital in-patient
• Form H2 section 5(4) - record of hospital in-patient
• Form H3 sections 2, 3 and 4 - record of detention in hospital
• Form H4 section 19 - authority for transfer from one hospital to another under different managers
• Form H5 section 20 - renewal of authority for detention
• Form H6 section 21B - authority for detention after absence without leave for more than 28 days

Guardianship forms

• Form G1 section 7 - guardianship application by nearest relative
• Form G2 section 7 - guardianship application by an approved mental health professional
• Form G3 section 7 - joint medical recommendation for reception into guardianship
• Form G4 section 7 - medical recommendation for reception into guardianship
• Form G5 section 7 - record of acceptance of guardianship application
• Form G6 section 19 - authority for transfer from hospital to guardianship
• Form G7 section 19 - authority for transfer of a patient from the guardianship of one guardian to another
• Form G8 section 19 - authority for transfer from guardianship to hospital
• Form G9 section 20 - renewal of authority for guardianship
• Form G10 section 21B - authority for guardianship after absence without leave for more than 28 days

Miscellaneous forms

• Form M1 Part 6 - date of reception of a patient in England
• Form M2 section 25 - report barring discharge by nearest relative

Treatment forms

• Form T1 section 57 - certificate of consent to treatment and second opinion
• Form T2 section 58(3)(a) - certificate of consent to treatment
• Form T3 section 58(3)(b) - certificate of second opinion
• Form T4 section 58A(3) - certificate of consent to treatment (patients at least 18 years old)
• Form T5 section 58A(4) - certificate of consent to treatment and second opinion (patients under 18)
• Form T6 section 58A(5) - certificate of second opinion (patients who are not capable of understanding the nature, purpose and likely effects of the treatment)

Treatment forms - CQC Word documents

• T1 - Section 57 Certificate of consent to treatment and second opinion
• T2 - Section 58 - Certificate of consent to treatment
• T3 - Section 58(3) b) – Certificate of second opinion
• T4 - Section 58A (3) - Certificate of consent to treatment (patients at least 18 years old)
• T5 - Section 58A (4) – Certificate of consent to treatment and second opinion (patients under 18)
• T6 - Section 58A (5) - certificate of second opinion (patients who are not capable of understanding the nature, purpose and likely effects of the treatment)

CTO forms

• Form CTO1 section 17A - community treatment order
• Form CTO2 section 17B - variation of conditions of a community treatment order
• Form CTO3 section 17E - community treatment order - notice of recall to hospital
• Form CTO4 section 17E - community treatment order - record of patient's detention in hospital after recall
• Form CTO5 section 17F(4) - revocation of community treatment order
• Form CTO6 section 17F(2) - authority for transfer of recalled community patient to a hospital under different managers
• Form CTO7 section 20A - community treatment order - report extending the community treatment period
• Form CTO8 section 21B - authority for extension of community treatment period after absence without leave for more than 28 days
• Form CTO9 Part 6 - community patients transferred to England
• Form CTO10 section 19A - authority for assignment of responsibility for community patient to hospital under different managers
• Form CTO11 section 64C(4) - certificate of appropriateness of treatment to be given to community patient (Part 4A certificate)