On-Call Resources

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 (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 (Notice to Patient - Incapacity)

• Patient is not capable to (one or more of the following):
  1. Consent to treatment (unable to understand AND/OR appreciate a proposed treatment)
     • Do a capacity assessment for your proposed treatment
     • You must immediately find a substitute decision maker (SDM) or if unable to locate, contact The Office of the Public Guardian and Trustee (OPGT)
  2. To manage property (AKA finances)
     • Do a financial capacity assessment and fill out a Form 21
     • Contact The Office of the Public Guardian and Trustee (OPGT)
     • Handout for Patients Deemed Financially Incapable
  3. To consent to release of their health information

Download Form 33

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

Download PPAO Form

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)

• 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 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)

• 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)

• Transfers patient on a Form 1 or Form 3 to another facility (e.g. - for surgery or medical clearance)

Download Form 10

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 (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)

• 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.

• Mental Health Act in Plain Language (Government of BC)

• BC Mental Health Act
• Mental Health Act Forms

• BC Pharmacare Program

• Capability and Consent Tool - B.C. Edition
• Globe and Mail: B.C. patients launch court challenge over forced psychiatric treatments
• Georgia Straight: B.C. patients challenge forced psychiatric treatment in bid for greater say in mental-health care

suicide-risk-assessment

PDFs

• How to Write a SRA
• Suicide Risk Assessment (APA)
• Suicide Risk Assessment Template (CAMH)
• Child and Adolescent Suicide Assessment Template (SickKids)

Neurological Emergencies

Internal Medicine Emergencies and Issues

Consider:

• 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: consider CT head, ECG, or CXR

• Medical Screening Suggestions
• Toronto Notes - On-Call STAT Notes
• ER Medical Screening of Psychiatric Patients

Pharmacological Management of Acute Behavioural Agitation

Emergency Capacity Assessment

Medications

• Understanding Psychiatric Medications, 3rd Edition Handouts
• Understanding Antidepressants
• Understanding Antipsychotics
• Understanding Benzodiazepines
• Understanding Mood Stablizers

Handouts, Worksheets and Workbooks for Various Mental Disorders

• Centre for Clinical Interventions (Great Resource!)

Therapy Handouts

• Grounding for Emotional Pain (Provider + Patient)
• Pleasurable Activities
• Assertiveness
• Emotions
• Feelings
• Trauma Therapy Toolkit
• Mood Charting - Depression Log (PDF)

• Choosing Wisely Canada: Psychiatry

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

In Ontario, the Highway Traffic Act requires that 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 him or her to operate a motor vehicle. This act was most recently updated in 2018, and has new mandatory reporting situations.

Forms

• Medical Condition Report Form
• How to Complete the Medical Condition Report Form

• CMA Driver's Guide 8th Edition
• Dementia and Driving Toolkit

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.

Developmental Milestones

• Ontario Age-Based Milestones

• Police Handover Flowsheet
• Disclosing Patient Information to Police
• Police Handover Protocol

• Resident Checklist Before Reviewing
• On-Call Supervision Record

CAMH On-Call (password-protected)

St. Michael's On-Call (password-protected)

Sunnybrook On-Call (password-protected)