Form 7 "Application for Patient to Move out of Queensland" - Queensland, Australia

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Proceeding No:
/
MENTAL HEALTH COURT
Application for patient to move out of Queensland
Mental Health Act 2000 Queensland
Section 288B
Form No: MHC.07
The Mental Health Court may, on application made to it, when making a forensic order, approve under
the order that the patient move out of Queensland. Such approval may only be given if the Court is
satisfied that the appropriate arrangements exist for the patient’s care or treatment at the place where
the patient is to move.
Person’s details
BLOCK LETTERS
The person who is the
Given name/s
Family name
subject of the application
Residential address
Town/suburb
State
Postcode
or
Age
Date of birth
/
/
PLEASE PRINT
Outstanding charges
Does the person have outstanding charges not dealt with by
the Mental Health Court?
YES
NO
If yes, specify bail conditions
If yes, specify any future court date/s
/
/
/
/
Applicant’s details
Tick  applicable box
Director of Mental Health
Legal Representative
Patient
 Specify relationship
Person on behalf of the patient
Name of applicant
Given name/s
Family name
Applicant
Signature
Date
/
/
Applicant’s address &
Address
Town/suburb
State
Postcode
phone number
Phone No.
To:
Registrar, Mental Health Court
GPO BOX 48, BRISBANE QLD 4001
To be completed by Registrar, Mental Health Court
Notice
seal
Registrar, Mental
Signature
Health Court
Print name
Date
/
/
To:
the parties to the proceedings
continued over page…
version 1
May 2005
Proceeding No:
/
MENTAL HEALTH COURT
Application for patient to move out of Queensland
Mental Health Act 2000 Queensland
Section 288B
Form No: MHC.07
The Mental Health Court may, on application made to it, when making a forensic order, approve under
the order that the patient move out of Queensland. Such approval may only be given if the Court is
satisfied that the appropriate arrangements exist for the patient’s care or treatment at the place where
the patient is to move.
Person’s details
BLOCK LETTERS
The person who is the
Given name/s
Family name
subject of the application
Residential address
Town/suburb
State
Postcode
or
Age
Date of birth
/
/
PLEASE PRINT
Outstanding charges
Does the person have outstanding charges not dealt with by
the Mental Health Court?
YES
NO
If yes, specify bail conditions
If yes, specify any future court date/s
/
/
/
/
Applicant’s details
Tick  applicable box
Director of Mental Health
Legal Representative
Patient
 Specify relationship
Person on behalf of the patient
Name of applicant
Given name/s
Family name
Applicant
Signature
Date
/
/
Applicant’s address &
Address
Town/suburb
State
Postcode
phone number
Phone No.
To:
Registrar, Mental Health Court
GPO BOX 48, BRISBANE QLD 4001
To be completed by Registrar, Mental Health Court
Notice
seal
Registrar, Mental
Signature
Health Court
Print name
Date
/
/
To:
the parties to the proceedings
continued over page…
version 1
May 2005
Proceeding No:
/
PLEASE PRINT
Arrangement details
 Does the patient
Travel arrangements
need to be
accompanied on
travelling interstate?
Include details of any
relevant travel costs
Treatment and ongoing care
Include details of:
 treating psychiatrist
or interstate mental
health service
 proposed initial
medical appointment
with interstate service
(including date, time
and treating
psychiatrist)
Residential arrangements
Where is the patient to
reside
Address
Town/suburb
State
Postcode
Phone No.
Social circumstances
Include details of:
 social networks
interstate
 carer or other
significant
relationships
 opportunities for
patient to find/resume
work
Specify any other
Other arrangements
relevant arrangements
version 1
May 2005
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