On-Call Resources

Patient Care

Patient Looks Unwell!

Basic Life Support (BLS)

Neurological Emergencies

Internal Medicine Emergencies and Issues

Physical Exam in Psychiatry and "Medical Clearance"


  • Withdrawal: Alcohol, GHB, opioids, other drugs
  • Bloodwork: consider CBC, electrolytes, BUN, creatinine, glucose, blood alcohol, urine drug screen. Always consider doing a beta hCG in females of reproductive age.
  • Investigations:
    • CBC, electrolytes, BUN, Creatinine, Glucose
    • Urine or serum toxicology (including alcohol levels)
    • Consider CT head, ECG, or CXR
    • For females between ages 12 to 55, bHCG should be ordered

Choosing Wisely Canada

Should I Talk to Police About a Patient?

Health care providers have an ethical, professional, and legal responsibility to safeguard the personal health information of their patients. Absent a patient’s consent, such information should only be shared with others in exceptional circumstances (e.g., imminent risk of harm to others, danger to a child).

It's Time to Review Case With Staff!


  • Diagnosis and Comorbidities
    • Is this diagnosis based on historical diagnosis or presentation today?
    • Is the patient currently intoxicated?
    • How much is substance abuse contributing to this picture?
    • What medical comorbidities may be contributing>?
  • Collateral
    • Have you reviewed past medical records?
    • Spoke with the emergency room physician or referring physician?
    • Have you spoken to any community supports, family, or other collateral
  • Safety
    • Does this patient have a past history of violence/aggressive behavior/agitation?
    • Is the patient currently agitated?
    • Have you put any de-escalation or preventative procedures in place?
    • What are the risk factors for suicide in this patient
    • Does this patient require “medical clearance”?
  • Reporting Issues
    • Are there children at risk?
    • Is there a driving risk?
    • Do you have a duty to warn?
  • Legal Status
    • Is the patient voluntary or involuntary?
    • Is there legal or forensic involvement?
    • Depending on the jurisdiction, have all applicable mental health forms been completed?
    • Does the patient consent to us speaking or relaying information to family or friends?
  • Disposition
    • If admitting:
      • What is the rationale for admission?
      • What are the specific goals of admission?
    • If discharging:
      • Have you done a suicide risk assessment?
      • What are the protective factors that allow us to discharge the patient?
      • Is there a safety plan for the patient?
      • What supports or referrals are in place for the patient?

What Needs To Be Reported?

    • Registrants (Physicians)
      • Duty to report registrants's whose practice may constitute a danger to the public
      • Duty to report respecting hospitalized registrant (mental health or addictions)
      • Duty to report sexual misconduct
    • Deaths that require reporting in the province
    • Child welfare/safety concerns
    • Driving safety concerns

Should I Report My Patient's Driving?

The Motor Vehicles Act (Section 230) of British Columbia states that registered psychologists, optometrists and medical practitioners must report patients to the Office of the Superintendent of Motor Vehicles (OSMV) if:

  1. A patient has a medical condition that makes it dangerous to the patient, or to the public, for the patient to drive a motor vehicle, AND
  2. Continues to drive after the psychologist, optometrist or medical practitioner warns the patient of the danger.

“No action for damages lies or may be brought against a psychologist, an optometrist or a medical practitioner for making a report under this section, unless the psychologist, optometrist or medical practitioner made the report falsely and maliciously.”

Fitness to Drive

Individuals may drive if:

  1. Their condition is stable
  2. They have been assessed as having sufficient insight to stop driving if their condition becomes acute
  3. They are compliant with any prescribed psychotropic medication regime or other recommended treatment, including regular follow-up where required
  4. For commercial drivers who have had a psychotic episode, a specialist is supportive of their return to driving, and
  5. Their functional abilities necessary for driving are not impaired


Should I Report to the Ministry of Child and Family Development?

“All registrants are required by law to report a child in need of protection. In the Child, Family and Community Service Act (CFCSA), a child is defined as someone under the age of 19.” – College of Physicians and Surgeons of British Columbia

All circumstances of suspected child risk, abuse and neglect must be reported to appropriate child protection agencies at the time of assessment. If you are not sure whether reporting is necessary, you can call and discuss the situation without using the patient’s name. If child protective services advises that you must report, then identifying information must be given to them. There is someone available to receive your call 24 hours a day, 365 days a year.


    • Phone line for adults seeking withdrawal and detox management services who live in the Vancouver Coastal Health region.
    • Individuals receive a clinical assessment and same-day substance-use virtual care provided by addiction specialists, providers, and nurses, with support from Access referral workers.
    • Access Central phone lines are open 7 days a week from 9 a.m. to 7:45 p.m. at 1-866-658-1221

Borderline Personality Disorder

Child, Youth, and Adolescent

Traumatic Brain Injury

What Needs To Be Reported?

Reporting to an agency or organization can either be mandatory or permissive. Refer to the CPSO guidelines for full details. Mandatory reporting situations:

  1. Child Abuse or Neglect
  2. Impaired Driving Ability
  3. Long-Term Care and Retirement Homes
  4. Sexual Abuse of a Patient (by Healthcare Provider)
  5. Facility Operators: Duty to Report Incapacity, Incompetence and Sexual Abuse
  6. Terminating or Restricting Employment
  7. Births, Still-births and Deaths
  8. Communicable and Reportable Diseases
  9. Controlled Drugs and Substances
  10. Community Treatment Plans
  11. Gunshot Wounds
  12. Pilots or Air Traffic Controllers
  13. Railway Safety
  14. Maritime Safety
  15. Occupational Health and Safety
  16. Correctional Facilities
  17. Preferential Access to Health Care

Should I Report My Patient's Driving?

The Highway Traffic Act requires physicians report a patient when they are of opinion that the individual has a medical condition or functional impairment that may make it dangerous for them to operate a motor vehicle. This act was most recently updated in 2018, and has new mandatory reporting situations.

Should I Report to a Children's Aid Society or the Ministry?

  • “Physicians who have reasonable grounds to suspect a child is in need of protection must report directly to a CAS, and not rely on any other person to report on their behalf.”The College of Physicians and Surgeons of Ontario: Mandatory and Permissive Reporting
  • All circumstances of suspected child risk, abuse and neglect must be reported to appropriate child protection agencies at the time of assessment. If you are not sure whether reporting is necessary, you can call and discuss the situation without using the patient’s name. If child protective services advises that you must report, then identifying information must be given to them. There is someone available to receive your call 24 hours a day, 365 days a year.

Key Terms:

  • Crown ward = the local children's aid has extended care of the child
  • Society ward = the local children's aid has custody of the child but if the parents are proven fit, the child will be returned
  • Apprehension = to bring a child to a place of safety
  • Age of Protection = A 16-17 year old can be brought to care of Children’s Aid Society under a Voluntary Youth Services Agreement (VYSA). Parental consent is not required.

Developmental Milestones

Common Forms

Form 1 (Psychiatric Assessment) + Form 42 (Notice to Patient)

How to Fill a Form 1/42 in 5 mins

Form 1 (Application by Physician for Psychiatric Assessment)

  • Detains patient for assessment only
  • Valid for 72 hours

Download Form 1

Form 42 (Notice to Patient)

  • Give original Form 42 to patient
  • Keep a copy in chart

Download Form 42

Form 3 (Involuntary Admission) + Form 30 (Notice to Patient)

Form 3 (Certificate of Involuntary Admission)

  • Involuntary admission for 14 days (REMEMBER: It is 14 days including the day you sign the form, therefore, you add only 13 days, NOT 14 days)
  • Same criteria as Form 1 - both Box A and B are available
  • A Form 30 must be given to patient immediately to notify them
  • Rights Advice must be notified
  • If you signed the Form 1, you cannot sign a Form 3 - it must be a different MD!

Download Form 3

Form 30 (Notice to Patient)

  • Give the original Form 30 to patient after a Form 3 or Form 4 is signed
  • Keep a copy in chart

Download Form 30

Form 33 (Finding of Incapacity)

Form 33 (Notice to Patient - Incapacity)

Download Form 33

Request for Rights Advice (PPAO)

Rights Advice Form (Request for Rights Advice Mental Health Inpatient)

  • You must notify the Psychiatric Patient Advocate Office (PPAO) each time a patient is placed on a Form 3, Form 4, Form 21, or given a Form 33
  • A rights advisor will arrive to see patient and inform them of their legal rights to challenge the admission

PPAO Request

All Forms

Form 2 (Order For Examination)

Form 2 (Order For Examination)

  • Is a form that any member of the public (or family member) can fill out and ask a Justice of the Peace to sign
  • Gives police 7 days to bring someone to hospital
  • Police will bring patient to a hospital for assessment
  • Does not authorize patient to be detained at the hospital; still must complete a Form 1 to keep them in hospital!

Download Form 2

Form 4 (Certificate of Renewal)

Form 4 (Certificate of Renewal)

  • The first Form 4 lasts one month (add 1 month, minus 1 day)
    • Second Form 4 lasts two months (add 2 months, minus 1 day)
    • Third Form 4 lasts three months (add 3 months, minus 1 day)
  • Rights advice must be notified
  • Give Form 30 each time, plus patient can appeal each time
  • There is also a Form 4A (“Fourth Form 4”) (also 3 months, minus 1 day)

Download Form 4

Form 5 (Change to Voluntary Status)

Form 5 (Change to Informal or Voluntary Status)

  • Fill out this form to end a Form 3 or Form 4 (i.e. - make a patient voluntary again)
  • You do not need to fill this out to cancel a Form 1, simply either document are cancelling the Form 1, or cross out the Form 1

Download Form 5

Form 9 (Order for Return)

Form 9 (Order for Return)

  • Used find patients who go AWOL while involuntarily admitted (Form 1, Form 3, Form 4)
  • Police will look for patient and take them back to hospital

Download Form 9

FAQ on Filling a Form 1 after a Form 9

Form 10 (Transfer of Patient) and Form 11 (Transfer of Patient for Medical Treatment)

A Form 10 or Form 11 needs to be completed if a patient is being transferred from one facility to another.

Form 10 (Transfer of Patient)

  • Transfers patient on a Form (e.g. - 3, 4 or 4A) from one facility to another
  • This is usually a permanent transfer and the patient can be discharged

Download Form 10

Form 11 (Transfer of Patient for Medical Treatment)

  • Transfers patient on a Form (e.g. - 3, 4 or 4A) to another facility for medical treatment or medical clearance that cannot be provided at the current facility
  • If the patient is to return back to the original facility, do not discharge the patient from the original facility yet, as this will invalidate the current MHA Form! Only discharge the patient if you are certain they are not returning
  • A copy of the current MHA Form (e.g. - 3, 4 or 4A) must be provided to the hospital treating the patient

Download Form 11

The Form 10 and Form 11 requires the signature of an Officer-in-Charge, and this can be any one of:

  • Physician-in-Chief
  • Chief of Nursing
  • Medical Directors
  • Medical Heads
  • Hospitalists
  • Unit Manager
  • After hours: duty physician, on-call resident, or after-hours manager
NOTE: The patient's attending physician cannot sign as the officer-in-charge, even if they happen to be acting in one of the above roles.

Form 21 (Certificate of Financial Incapacity)

Form 21 (Certificate of Incapacity to Manage One's Property)

  • MD fills out this Form to explain why the finding of financial incapacity was made
  • Form 33 must be given to patient to notify them of this finding

Download Form 21

Form 45, 47, and 49 (Community Treatment Order)

Form 45 (Community Treatment Order)

  • Allows a physician to mandate supervised treatment on a patient when they are discharged from hospital
  • Can be voluntary (i.e. - patient requests the CTO), or more commonly involuntary (MD initiates the CTO)

Download Form 45

Form 47 (Order for Examination)

  • Issued when patient violates their CTO conditions (i.e. - does not show up for appointments/medication)
  • Allows police to recall patient to hospital for assessment
  • Once at a hospital, the patient must be issued a Form 1 - a Form 47 by itself does not allow for involuntary detention

Download Form 47

Form 49 (Notice/Intention to Start CTO)

  • This is issued to the patient to notify them of your intention to start or renew a CTO

Download Form 49

Form 49 (Warrant of Committal)

Confusion Alert! There are 2 VERY different Form 49s! The other Form 49 is for CTOs (Notice/Intention to Start CTO).

Form 49 (Warrant of Committal)

  • Issued through the Ontario Review Board (ORB), which is essentially a detention order. The patient does not need any additional Forms signed once brought to the hospital and can be involuntarily detained by default.

Child, Youth, and Adolescent




Referrals and Services


Drug and Alcohol Helpline

  • 1-800-565-8603

Gerstein Substance Use Crisis Team + Beds

  • 7 Short Term Residential Crisis Beds for up to 30 days is available through partnerships with University Health Network Ossington Withdrawal Management Centre (six beds for men) and Eva’s Satellite (1 bed for youth).
  • Individuals in crisis can access these services 24 hours/day through the crisis line at 416-929-5200 or can contact the team directly during business hours at 647-215-5386 (Daniel) or 647-637-2678 (Laura).

Crisis and Support Lines

Shelters and Housing

Emergency Shelters

Housing/Shelter Central Access Intake

  • 416-338-4766
  • Dial 311: for shelter info and street outreach

CATCH Homeless Program

  • For homeless adults who are having trouble accessing medical services in the downtown area.
  • 416-864-5347

Streets to Homes Assessment and Referral Centre

  • 129 Peter Street (Mutual Contact Sheet)
  • If you are serving someone you learn or suspect is connected to either team, please use the Mutual Contact Sheet
  • These teams are within the circle of care for assessment, treatment and discharge planning
  • For assistance for individuals who may be living rough or on the street, please contact the Street Outreach Shift Leader, who is available 24/7 at 416-397-5182 or dial 311.
  • To refer to a shelter: 416-392-0090. Shelter Referral Access Point staff can assist by identifying where appropriate shelter beds are available.

Multi-Disciplinary Outreach Team (M-DOT)

  • Specialized team of providers from various organizations that delivers services to the most vulnerable individuals on the street and in shelters. The team helps their clients find housing, medical attention, income supports, or addictions services. (Mutual Contact Sheet)
  • During business hours (9am-5pm), contact the Program Manager, Mariruth Morton at 416-712-8221.
  • M-DOT can fax or deliver collateral information upon request.
  • After hours, messages can be left and will be returned the next morning (on weekends, calls will be returned the following Monday).
  • If immediate support is needed after hours or on weekends, ED staff can call the Streets to Homes Outreach Shift Leaders at 416-397-5182. The Streets to Homes Shift Leaders can send a team out (if available) to connect with the person. The Streets to Homes Shift Leaders will then communicate with MDOT on the next business day regarding any needed ongoing support.

OW, ODB, ODSP, EI, and Disability

Ontario Drug Benefit (ODB)

Ontario Disability Support Program (ODSP)

Ontario Works (OW)

CPP Disability Benefits

Employment Insurance (EI)

Apps + Websites