Forms
Prescribed Forms These are the legal forms used to record and justify the use of statutory powers under the Mental Health (Northern Ireland) Order 1986.
Guidence notes come first where available.
Forms are double sided and usually printed on pink paper.
| Form 1 | Application by Nearest Relative For Admission for Assessment |
| Form 2 | Application by an Approved Social Worker For Admission for Assessment |
| Form 3 | Medical Recommendation For Admission for Assessment |
| Form 4 | Medical Certificate To Extend Time Limit For Conveying Patient To Hospital |
| Form 5 | Medical Practitioner's Report on Hospital In-Patient Not Liable To Be Detain |
| Form 6 | Nurse's Record in Respect of Hospital In-Patient Not Liable To Be Detained |
| Form 7 | Report of Medical Examination Immediately After Admission For Assessment |
| Form 8 | Extension of Assessment Period From 48 Hours to 7 Days – Medical Report |
| Form 9 | Medical Report to Extend Assessment Period For a Further 7 Days |
| Form 10 | Medical Report For Detention For Treatment |
| Form 11 | Report By Responsible Medical Officer For Renewal of Authority For Detention For 6 Months or One Year |
| Form 12 | Joint Medical Report For First Renewal of Authority For Detention For One Year |
| Form 13 | Guardianship Application By Nearest Relative |
| Form 14 | Guardianship Application By Approved Social Worker |
| Form 15 | Joint Medical Recommendation For Reception Into Guardianship |
| Form 16 | Medical Recommendation For Reception Into Guardianship |
| Form 17 | Recommendation By An Approved Social Worker For Reception Into Guardianship |
| Form 18 | Report By Responsible Medical Officer For Renewal Of Authority for Guardianship |
| Form 19 | Report by Approved Social Worker for Renewal of Authority For Guardianship |
| Form 20 | Assignment of Functions By Nearest Relative |
| Form 21 | Certificate of Consent to Treatment and Second Opinion |
| Form 22 | Certificate of Consent to Treatment |
| Form 23 | Certificate of Second Opinion |
| Form 24 | Medical Report on Patient Removed to Northern Ireland |
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Non-Prescribed (Internal) Forms These are the forms used to facilitate the operation of other functions under the Mental Health (Northern Ireland) Order 1986. These are sample forms only and are customised for the use within BHSCT.
| Form 1 | Report To Responsible Medical Officer On Patient's Social Circumstances |
| Form 2 | Record Of Time At Which Power To Detain Under Article 7(3) Elapsed |
| Form 3 | Notification To Regulation And Quality Improvement Authority Of Any Amendments Made To Applications, Recommendations Or Reports |
| Form 4 | Order Of Discharge Of Patient Liable To Be Detained In Hospital By Responsible Medical Officer/Responsible Health And Social Care Trust |
| Form 5 | Discharge Of Patient Liable To Be Detained In Hospital By Nearest Relative |
| Form 6 | Report Barring Discharge From Hospital By Nearest Relative |
| Form 7 | Notification To Regulation And Quality Improvement Authority Of Patient's Discharge From Detention |
| Form 8 | Notification To Regulation And Quality Improvement Authority Of L eave Of Absence From Hospital Or Extension Of Leave |
| Form 9 | Notification To Regulation And Quality Improvement Authority Of Recall Or Return To Hospital From Leave Of Absence |
| Form 10 | Notification To Regulation And Quality Improvement Authority Of Any Amendments To Guardianship Applications Or Recommendations |
| Form 11 | Renewal Of Authority For Guardianship Report By Second Medical Practitioner |
| Form 12 | Discharge Of Patient From Guardianship By Responsible Medical Officer |
| Form 13 | Discharge Of Patient From Guardianship By Authorised Social Worker |
| Form 14 | Discharge Of Patient From Guardianship By Nearest Relative |
| Form 15 | Report By Responsible Medical Officer/Authorised Social Worker Barring Discharge Of Patient From Guardianship By Nearest Relative |
| Form 16 | Notification To Regulation And Quality Improvement Authority When Patient Is Discharged From Guardianship |
| Form 17 | Notification To Regulation And Quality Improvement Authority On The Transfer Of Guardianship On Death, Incapacity, Etc Of Guardian |
| Form 18 | Notification To Regulation And Quality Improvement Authority Of Detained Patient's Transfer To Another Hospital |
| Form 19 | Notification To Regulation And Quality Improvement Authority Of Detained Patient's Transfer Into Guardianship |
| Form 20 | Notification To Regulation And Quality Improvement Authority Of Transfer Of Patient Between Guardians |
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