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  4. M.R. 145/99
This is an unofficial version. If you need an official copy, use the bilingual (PDF) version.

Note:     The PDF version of the regulation does not include the prescribed form(s).
This HTML version includes links to the form(s).

As of April 27, 2024, this is the most current version available.

 

This is the first version. It has been in effect since October 29, 1999.

Prescribed forms

Note:     The PDF and HTML versions of this regulation do not include the forms prescribed by it.
The forms on this site are published only as individual files in PDF format,
but they are available in an alternate format on request.
Please contact Manitoba Government Inquiry at mgi@gov.mb.ca for more information.

Note:    Each of the following is a PDF image of the prescribed form.  Each form is designed to be completed as a set with the original and one or more copies to be provided to different parties.  The printed form sets are available on request from the Director of Psychiatric Services.

Schedule or Form Title
Form 1 Application for an Order for Involuntary Medical Examination bilingual
Form 2 Order for Involuntary Medical Examination bilingual
Form 3 Notice to Person in Custody bilingual
Form 4 Application by Physician for Involuntary Psychiatric Assessment bilingual
Form 5 Application by Attending Physician for Change of Patient's Status from Voluntary to Involuntary bilingual
Form 6 Involuntary Admission Certificate bilingual
Form 7 Renewal Certificate bilingual
Form 8 Certificate of Change of Status to Voluntary Patient bilingual
Form 9 Certificate of Incompetence to make Treatment Decisions bilingual
Form 10 Certificate of Incompetence to Manage Property bilingual
Form 11 Attending Physician's Statement that Patient in Psychiatric Facility has Regained Competence bilingual
Form 12 Notice of Cancellation of Certificate of Incompetence bilingual
Form 13 Request for Discharge by Voluntary Patient bilingual
Form 14 Order for Return of Patient Absent Without Permission bilingual
Form 15 Leave Certificate or Extension of Leave bilingual
Form 16 Revoke or Amend Leave Certificate bilingual
Form 17 Cancellation of Leave Certificate bilingual
Form 18 Patient's Application to Mental Health Review Board bilingual
Form 19 Facility's Application to Mental Health Review Board bilingual
Form 20 Authorization of Transfer bilingual
Form 21 Certificate of Incapacity bilingual
Form 22 Order of Committeeship bilingual
Form 23 Physician's Statement that Person is no Longer Incapable of Managing Property or of Personal Care bilingual
Form 24 Notice of Cancellation of Certificate of Incapacity and Order of Committeeship bilingual
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Mental Health Act Forms Regulation, M.R. 145/99

Règlement sur les formules applicables en matière de santé mentale, R.M. 145/99

The Mental Health Act, C.C.S.M. c. M110

Loi sur la santé mentale, c. M110 de la C.P.L.M.

Regulation 145/99
Registered October 15, 1999

bilingual version (HTML)

Règlement 145/99
Date d'enregistrement : le 15 octobre 1999

version bilingue (HTML)
Forms prescribed

1   Forms 1 to 24 are prescribed for use under The Mental Health Act.

Formules prescrites

1   Les formules 1 à 24 sont prescrites en vertu de la Loi sur la santé mentale.

Repeal

2   Manitoba Regulation 189/91 is repealed.

Abrogation

2   Le Règlement du Manitoba 189/91 est abrogé.

Coming into force

3   This regulation comes into force on proclamation of The Mental Health and Consequential Amendments Act, S.M. 1998, c. 36.

Entrée en vigueur

3   Le présent règlement entre en vigueur en même temps que la Loi sur la santé mentale et modifications corrélatives, c. 36 des L.M. 1998.

October 14, 1999Minister of Health/

14 octobre 1999Le ministre de la Santé,

David W. Chomiak

TABLE OF FORMS

Note: Each of the following is a PDF image of the prescribed form.  Each form is designed to be completed as a set with the original and one or more copies to be provided to different parties.  The printed form sets are available on request from the Director of Psychiatric Services.

TABLEAU DES FORMULES

Note :    Les formules réglementaires qui suivent sont accessibles sous forme d’images en format PDF. Il est prévu que chaque formule comprenne un ensemble de copies — y compris l’original — à remplir, chacune d’elles devant être remise à une partie différente.  Vous pouvez demander au directeur des Services psychiatriques de vous fournir les ensembles de formules imprimées.

Form 1Application for an Order for Involuntary Medical Examination

Formule 1Requête en vue de l'obtention d'une ordonnance d'examen médical obligatoire

Form 2Order for Involuntary Medical Examination

Formule 2Ordonnance d'examen médical obligatoire

Form 3Notice to Person in Custody

Formule 3Avis à la personne appréhendée

Form 4Application by Physician for Involuntary Psychiatric Assessment

Formule 4Demande d'évaluation psychiatrique obligatoire

Form 5Application by Attending Physician for Change of Patient's Status from Voluntary to Involuntary

Formule 5Demande visant le placement en cure obligatoire d'un malade en cure volontaire

Form 6Involuntary Admission Certificate

Formule 6Certificat d'admission en cure obligatoire

Form 7Renewal Certificate

Formule 7Certificat de renouvellement

Form 8Certificate of Change of Status to Voluntary Patient

Formule 8Certificat de changement de statut

Form 9Certificate of Incompetence to make Treatment Decisions

Formule 9Certificat d'incapacité mentale de prendre des décisions liées au traitement

Form 10Certificate of Incompetence to Manage Property

Formule 10Certificat d'incapacité de gérer des biens

Form 11Attending Physician's Statement that Patient in Psychiatric Facility has Regained Competence

Formule 11Déclaration du médecin traitant indiquant que le malade d'un établissement psychiatrique a retrouvé sa capacité mentale

Form 12Notice of Cancellation of Certificate of Incompetence

Formule 12Avis d'annulation du certificat d'incapacité

Form 13Request for Discharge by Voluntary Patient

Formule 13Demande de congé d'un malade en cure volontaire

Form 14Order for Return of Patient Absent Without Permission

Formule 14Ordre visant le retour du malade qui s'est absenté de l'établissement sans permission

Form 15Leave Certificate or Extension of Leave

Formule 15Certificat d'autorisation ou prorogation du certificat d'autorisation

Form 16Revoke or Amend Leave Certificate

Formule 16Révocation ou modification du certificat d'autorisation

Form 17Cancellation of Leave Certificate

Formule 17Annulation du certificat d'autorisation

Form 18Patient's Application to Mental Health Review Board

Formule 18Demande d'un malade à la Commission d'examen des questions liées à la santé mentale

Form 19Facility's Application to Mental Health Review Board

Formule 19Demande d'un médecin traitant ou d'un directeur médical à la Commission d'examen des questions liées à la santé mentale

Form 20Authorization of Transfer

Formule 20Autorisation de transfert

Form 21Certificate of Incapacity

Formule 21Certificat d'incapacité

Form 22Order of Committeeship

Formule 22Ordre de nomination du curateur public

Form 23Physician's Statement that Person is no Longer Incapable of Managing Property or of Personal Care

Formule 23Déclaration du médecin indiquant qu'une personne n'est plus incapable de gérer ses biens ou de s'occuper de ses soins personnels

Form 24Notice of Cancellation of Certificate of Incapacity and Order of Committeeship

Formule 24Avis d'annulation du certificat d'incapacité et de l'ordre de nomination du curateur public