What the Form 1 is for
A Form 1 is the application a physician makes under section 15 of the Mental Health Act for a psychiatric assessment. It authorizes taking the person into custody and bringing them to a psychiatric facility, but it doesn’t admit them. At the facility, an attending physician decides within 72 hours whether to release them, admit them voluntarily, or certify them on a Form 3.
It’s often confused with a Form 2, which a justice of the peace issues when the person hasn’t been examined by a physician, and with a Form 3, which only the attending physician at the facility can sign.
Who completes it
Only the physician who personally examined the person completes and signs the Form 1. The examination must be within the past seven days. The patient doesn’t complete any part. Once the person is detained at the facility, the attending physician there notes the date and time detention began and the date and time they gave the person a Form 42.
How to fill in the application
Physician and examination details
Print your name, address, telephone and fax, the date you examined the person, their full name, and their home address. The Act requires the date of examination on the form, and the seven-day clock for signing runs from it.
Box A: serious harm test
Box A has two parts, and both are needed. The past or present test asks whether the person has threatened or attempted self-harm, behaved violently toward someone, caused someone to fear bodily harm, or shown a lack of competence to care for themselves. The future test asks whether a mental disorder will likely result in serious bodily harm to the person or another, or serious physical impairment. Check at least one item in each part.
Box B: incapable patients who meet the specified criteria
Use Box B for a person with a previously treated, recurring disorder who improved with treatment and is now deteriorating. All five conditions must be met, including that the person is incapable of consenting to treatment in a psychiatric facility and that their substitute decision-maker has consented. If you can’t confirm the substitute decision-maker’s consent, Box B doesn’t apply.
Your observations and facts from others
Each box asks for the information you based your opinion on, split into your own observations and facts communicated to you by others. The Act requires you to keep the two apart. Write what you saw and heard in the examination, then what family, police, or other clinicians reported, with who said it.
Signature, date and time
Sign with today’s date and time after confirming you made careful inquiry into the facts. The authority to take the person into custody lasts seven days from the day you sign.
Common reasons it’s found defective
- Signed more than seven days after the examination.
- Box A completed with the past or present test but no future test, or the reverse.
- Box B used without the substitute decision-maker’s consent.
- Observations and third-party reports run together, or no facts given at all.
- Missing date of examination, signature, or time.
- Signed by someone who isn’t a physician.
Submitting and who pays
The form isn’t sent to the ministry. It goes with the person to the psychiatric facility, usually carried by police or ambulance, and a copy stays in your chart. OHIP pays the physician under fee code K623, application for psychiatric assessment, which covers the history, examination, notifications, and completing the form.