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Form 42 (1787-41)

Notice to Person under Subsection 38.1 of the Act of Application for Psychiatric Assessment under Section 15 or an Order under Section 32 of the Act

Once someone held on a Form 1 or a Minister's order arrives and detention begins, the attending physician must promptly give them a Form 42. It restates the grounds the examining physician certified, and it tells the person they can be held for up to 72 hours and have the right to a lawyer without delay.

At a glance

Checked October 2026

Form number
Form 42 (1787-41)
Issued by
Ontario Ministry of Health
Where
Ontario
Completed by
Attending physician at the psychiatric facility
Format
Fillable PDF
Language
English and French

What the Form 42 is for

Section 38.1 of the Mental Health Act requires the attending physician of a person held on an application for psychiatric assessment, or on a Minister’s order under section 32, to promptly give that person written notice. The Form 42 is that notice. It tells the person who examined them, the grounds that physician certified, that they can be held for up to 72 hours, and that they can retain a lawyer without delay.

The Form 42 is often confused with the Form 30, which is the notice that follows a Form 3 certificate.

Who completes it

The attending physician at the psychiatric facility completes, signs and delivers it. The person it’s addressed to doesn’t complete any part. The examining physician who signed the Form 1 normally isn’t involved, though the facility will need their name and the date of their examination.

How to fill in the notice

Part I: application for psychiatric assessment

Complete Part I when the person is held on a Form 1. Enter the person’s name and home address, the name of the physician who signed the Form 1, and the date of that physician’s examination. Copy these from the Form 1 so the two documents agree.

Part A and Part B

Part A and Part B mirror Box A and Box B of the Form 1, and at least one must be completed. Check the same grounds the examining physician checked. Part A covers the serious harm grounds. Part B covers a previously treated person who is now incapable of consenting and whose substitute decision-maker has consented. Checking grounds that don’t appear on the Form 1 makes the notice inaccurate.

Part II: order under section 32

Complete Part II only when the person is held on an order from the Minister of Health under section 32. Enter the Minister’s name, the grounds checked in the order, and the date of the order.

Signature and date

Sign and date the part you used. Then record the date and time you delivered the Form 42 on the Form 1, in the section for use at the psychiatric facility.

Common reasons it’s found defective

  • Not delivered promptly once detention began.
  • Grounds that don’t match the Form 1 or the section 32 order.
  • Both Part I and Part II completed, or the wrong part used.
  • Delivery time not recorded on the Form 1.
  • Unsigned or undated.

Submitting and who pays

The notice is handed to the person, and a copy stays in the hospital record with the Form 1. Nothing goes to the ministry. The Schedule of Benefits’ Mental Health Act services are K620, K623, K624 and K629, and none is for the Form 42 on its own.

Get the official form

Download the current version from Ontario Ministry of Health each time. Forms change without notice, and an old edition can be returned.

Official page ↗ PDF ↗ Version française ↗

Medulla Forms

Fill Form 42 (1787-41) from the visit and the chart.

Upload the fillable PDF to your practice's forms once. Medulla fills it from the visit and the chart open in your EMR, leaves blank anything the record doesn't support, and opens the form for your review. When it's done, save it to the patient's chart in one click.

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Sources for this guide

Questions

Questions we hear a lot.

Who gives the patient the Form 42?

The attending physician of the person held on the application or order. The Form 1 itself reminds the facility's attending physician to note when detention began and to give the Form 42 promptly.

Is the Form 42 the same as the Form 30?

No. The Form 42 goes to a person held for assessment on a Form 1 or a section 32 order. The Form 30 is the notice given after a certificate of involuntary admission, renewal or continuation is signed.

Does the family physician who signed the Form 1 complete the Form 42?

Usually not. The Act puts the duty on the attending physician at the psychiatric facility, who records on the Form 1 the date and time the Form 42 was delivered.

What must the notice say?

Section 38.1 of the Mental Health Act requires it to state the reasons for the detention and that the person has the right to retain and instruct counsel without delay.

Is patient information secure?

Yes. Medulla has a SOC 2 Type II report from an independent auditor, is HIPAA, PIPEDA, and PHIPA compliant, and is built and hosted in Canada, so patient data stays in the country and never gets pasted into consumer AI tools. Everything is encrypted in transit and at rest. See how we protect patient data.

More questions? Browse help.medulla.ca.