What Form 49 is for
Form 49 gives written notice that you are considering a community treatment order for the person. It sets out why the person qualifies, who their substitute decision-maker is when they are incapable, that a community treatment plan has been developed, and that they are entitled to rights advice and a lawyer.
The ministry guide describes the order of steps: you decide whether the person is capable of consenting to a plan, develop the plan with them or their substitute decision-maker, give them Form 49 and a copy of the plan, and notify a rights adviser. The order itself is Form 45, which you sign only after rights advice.
Who completes it
The physician considering the CTO completes all four parts and signs Part 4. The person and their substitute decision-maker receive it but complete nothing on it. The rights adviser later sends you a Form 50 confirming that advice was given or refused.
How to fill in the notice
Part 1, Notice of Intention
Name the person and tick the history that qualifies them: two or more admissions to a psychiatric facility, or 30 days or more in total, in the previous three years, or a previous CTO. Use the same history you will record on Form 45.
Part 2, Capacity to Consent
Complete this only when the person has been found incapable of consenting to the proposed plan. Enter the date of that finding and the name of the substitute decision-maker under the Health Care Consent Act. The substitute decision-maker also receives notice.
Part 3, Community Treatment Plan
Attach a copy of the plan. The form records your opinion, from an examination in the 72 hours before entering into the plan, that the person meets the five listed conditions. Check that date against your examination note, because an examination outside the 72 hours doesn’t support the notice.
Part 4, Rights Advice and Right to Counsel
Name the person and the substitute decision-maker, then enter the date of issue, your business address, the psychiatric facility if there is one, your printed name and your signature.
Common reasons it causes problems
- The examination was more than 72 hours before the plan was entered into.
- No copy of the community treatment plan attached.
- Part 2 completed for a capable person, or left blank for an incapable one.
- The rights adviser isn’t notified, so the Form 45 can’t be signed.
- A qualifying history that doesn’t match what goes on the Form 45.
Submitting and who pays
Form 49 isn’t sent to a payer. Give it, with the plan, to the person and to the substitute decision-maker if there is one, notify a rights adviser, and keep a copy in the record. Wait for confirmation on Form 50 before you sign the Form 45.