Examination Authority Part B Online Form

Comments

Transcription

Examination Authority Part B Online Form
APPLICATION FOR EXAMINATION AUTHORITY PART B – MENTAL HEALTH REVIEW TRIBUNAL
The following persons may apply to the Mental Health Review Tribunal for an Examination Authority:


A person (other than the Administrator of an Authorised Mental Health Service or a person authorized in writing by an
administrator of an AMHS) who applies for an Examination Authority, must receive advice from a doctor or Authorised
Mental Health Practitioner about the clinical matters for the person.
The approved form for the application of an Examination Authority (Part A) must include a statement by a doctor or an
Authorised Mental Health Practitioner as per sections 500(2), (3) and 502.
Section 502 Mental Health Act 2016 Queensland
Doctor or Authorised Mental Health Practitioner’s details
Name:
Click here to enter text.
Address:
Click here to enter text.
Phone number:
Click here to enter text.
Authorised Mental Health Practioner: Yes ☐ Name and AMHS Click here to enter text.
Doctor: Yes ☐
Name and practice details Click here to enter text.
I am a Doctor/Authorised Mental Health Practitioner and am of the opinion that the persons
behaviour, or other relevant factors can reasonably be considered to satisfy the requirements
under section 504 (2) Mental Health Act 2016.
[Please explain WHY:
For example: From what have you been told by the applicant, WHY is it likely or possible that the person to be
examined meets the requirements under section 504(2)?
The requirements under section 504(2) are:
 The person has or may have a mental illness;
 The person does or may not have the capacity to consent to be assessed for a mental illness;
 Reasonable attempts have been made to encourage the person to be assessed voluntarily for the person’s
mental illness or it is not practical to attempt to encourage the person to be assessed voluntarily for a mental
illness;
 There is , or maybe, an imminent risk, because of the person’s mental illness or suspected mental illness, of
serious harm to the person or someone else or, the person suffering serious mental or physical deterioration.
Explain what reported symptoms and behaviours led to your conclusions.
Click here to enter text.
What attempts have been made to encourage the person (to be examined) to be assessed
voluntarily for their possible mental illness or why is it not practical to attempt to encourage
the person to be assessed?
[Complete this section based on information from the applicant and attempts made by any relevant AMHS.]
Click here to enter text.
In your opinon, what types of assessment for this particular presentation are available?
[What are the options available for this person’s assessment.]
Click here to enter text.
How might the person (to be examined) be encouraged to seek voluntary assessment and care?
[In your opinion, what steps can be taken to examine the person voluntarily before an examination authority.]
Click here to enter text.
Declaration:
I have spoken to the applicant and provided the above written advice based on my professional expertise
and experience. I understand I will be contacted to verify that I made the above statement after
consultation / discussion with the applicant.
Name:
Click here to enter text.
Date:
Click here to enter text.
Signature:
Please send to:
Legal Officer
Mental Health Review Tribunal
[email protected]
or
PO Box 15818,
Brisbane City East 4002
Page | 2
To be completed by designated officer of the Mental Health Review Tribunal by means of a
phone call or email that the advice in Part B was completed by a Doctor or an Authorised
Mental Health Practitioner:
[Consultation and written advice on clinical matters verified by designated officer of Mental Health Review:]
Name:
Click here to enter text.
Position and date:
Click here to enter text.
Page | 3

Similar documents