What the Form 4 is for
An involuntary patient can be held for up to two weeks on a Form 3. If they still meet the criteria at the end of that period, the attending physician renews their status with a Form 4. Section 20 of the Mental Health Act allows up to one additional month on a first renewal, two months on a second, and three months on a third. After that, the physician uses a certificate of continuation instead.
The Form 4 is different from the Form 5, which changes an involuntary patient to informal or voluntary status, and from a community treatment order, which applies outside hospital.
Who completes it
The attending physician completes and signs it after examining the patient. The patient doesn’t complete any part, but they must be given a written notice and a rights adviser must be notified.
How to fill in the certificate
Patient, physician, facility and examination date
Print the patient’s name, your name, the facility, and the date of your examination. Then state the patient’s current status: either subject to a certificate of involuntary admission or subject to an existing certificate of renewal, with the date it expires. Use the expiry date from the actual certificate, not an estimate.
Box A
You must be satisfied that both criteria are met. The patient’s mental disorder will likely result in serious bodily harm to themselves or another person, or serious physical impairment, unless they remain in custody. The patient isn’t suitable for continuation as an informal or voluntary patient.
Box B
You must be satisfied that all six criteria are met. These are the five Form 3 criteria for incapable patients, including the substitute decision-maker’s consent, plus a sixth: the patient isn’t suitable for continuation as an informal or voluntary patient.
Expiry date and signature
The certificate is effective on the date you sign it. Enter the date it expires, in day, month and year, matching the maximum period for this renewal: one month for the first, two for the second, three for the third. Then sign and date it.
Common reasons it’s found defective
- Neither Box A nor Box B completed. The form says one of them is required for it to be valid.
- An expiry date longer than the Act allows for this renewal number.
- The current certificate’s expiry date missing or wrong.
- Signed after the previous certificate expired, by which point the patient is already deemed voluntary.
- No notice to the patient or rights adviser after signing.
Submitting and who pays
The certificate is completed and filed with the officer in charge of the facility, who reviews it for compliance and must release the patient if it isn’t properly completed and the patient isn’t re-examined. OHIP pays the physician under fee code K629, which covers all re-certifications of involuntary admission, including completing the forms.