Form MHCTA-07 "Notification Advising a Person That a Community Treatment Order Is No Longer in Effect" - Newfoundland and Labrador, Canada

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Download Form MHCTA-07 "Notification Advising a Person That a Community Treatment Order Is No Longer in Effect" - Newfoundland and Labrador, Canada

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MENTAL HEALTH
Care & Treatment Act
Department of Health & Community Services
Mental Health Care and Treatment Act
Section 50(4)
PLEASE PRINT LEGIBLY
COPY:
Original
Patient
Patient Representative
Administrator
Rights Advisor
Treatment Plan Member: ___________________________
Notification Advising a Person
That a Community Treatment Order is No Longer in Effect
NOTICE TO:
___________________________________________________
(please print name of individual who is the subject of the CTO)
A community treatment order issued on __________________ pursuant to The Mental
(date)
Health Care and Treatment Act with respect to: _________________________________
(please print name of patient)
expired on _____________________, has not been renewed, and is no longer in force.
(date)
_____________________________
_____________________________
Signature of Attending Physician
Date
Regional health authorities acknowledge and respect the privacy of individuals. This personal information is being
collected under the Authority of Sections 32 and 33 of the Personal Health Information Act, and will be used for
plan of care. Please direct any questions about this collection to the Privacy Officer within your region.
Policy #1.30.70
Page 1 of 1
MHCTA-07
MENTAL HEALTH
Care & Treatment Act
Department of Health & Community Services
Mental Health Care and Treatment Act
Section 50(4)
PLEASE PRINT LEGIBLY
COPY:
Original
Patient
Patient Representative
Administrator
Rights Advisor
Treatment Plan Member: ___________________________
Notification Advising a Person
That a Community Treatment Order is No Longer in Effect
NOTICE TO:
___________________________________________________
(please print name of individual who is the subject of the CTO)
A community treatment order issued on __________________ pursuant to The Mental
(date)
Health Care and Treatment Act with respect to: _________________________________
(please print name of patient)
expired on _____________________, has not been renewed, and is no longer in force.
(date)
_____________________________
_____________________________
Signature of Attending Physician
Date
Regional health authorities acknowledge and respect the privacy of individuals. This personal information is being
collected under the Authority of Sections 32 and 33 of the Personal Health Information Act, and will be used for
plan of care. Please direct any questions about this collection to the Privacy Officer within your region.
Policy #1.30.70
Page 1 of 1
MHCTA-07