Form 23 "Recommendation / Request for Court Examination Order" - Queensland, Australia

ADVERTISEMENT
ADVERTISEMENT

Download Form 23 "Recommendation / Request for Court Examination Order" - Queensland, Australia

Download PDF

Fill PDF online

Rate (4.6 / 5) 10 votes
Page background image
Proceeding No:
Mental Health Court
Recommendation / request for
court examination order
Mental Health Act 2000 Queensland
Section 423
Form No: MHC.23
The Mental Health Court may order the person, who is the subject of a proceeding, to submit to an
examination by a stated psychiatrist, doctor or other health practitioner.
BLOCK LETTERS
Personal details
Given name/s
Family name
The person being
referred
Also known as
Residential address
Town/suburb
State
QLD
Postcode
Phone No.
Date of birth
Mark  applicable box
Male
Female
classified patient
BLOCK LETTERS
Nominated health practitioner
The health practitioner
Given name/s
Family name
requested / recommended
to examine the person the
Address
subject of the proceeding
Town/suburb
State QLD
Postcode
Phone No.
Notice
Mark
applicable box
assisting psychiatrist
Director of Public Prosecutions
Has recommended that the Mental Health Court make a court examination order for a proceeding for a
reference on the above mentioned person’s mental condition or an appeal against a decision of the Mental
Health Review Tribunal concerning the above person
The parties to the proceeding may make written submissions on this recommendation by
.
Mental Health Court
Signature
Print name: per. Bojan Stojanovic
Date
30 October 2015
If you require further information contact
(07) 3234 0703
the Registry of the Mental Health Court on
or
Mental Health Court Registry, GPO Box 48, BRISBANE QLD 4001
To:
Director of Mental Health
Director of Public Prosecutions
Director of Forensic Disability (if applicable)
Legal Aid Queensland
Office of the Adult Guardian (if applicable)
Attorney General (FO appeals only)
Legal Representative
Nominated health practitioner
version 1
March 2002
Proceeding No:
Mental Health Court
Recommendation / request for
court examination order
Mental Health Act 2000 Queensland
Section 423
Form No: MHC.23
The Mental Health Court may order the person, who is the subject of a proceeding, to submit to an
examination by a stated psychiatrist, doctor or other health practitioner.
BLOCK LETTERS
Personal details
Given name/s
Family name
The person being
referred
Also known as
Residential address
Town/suburb
State
QLD
Postcode
Phone No.
Date of birth
Mark  applicable box
Male
Female
classified patient
BLOCK LETTERS
Nominated health practitioner
The health practitioner
Given name/s
Family name
requested / recommended
to examine the person the
Address
subject of the proceeding
Town/suburb
State QLD
Postcode
Phone No.
Notice
Mark
applicable box
assisting psychiatrist
Director of Public Prosecutions
Has recommended that the Mental Health Court make a court examination order for a proceeding for a
reference on the above mentioned person’s mental condition or an appeal against a decision of the Mental
Health Review Tribunal concerning the above person
The parties to the proceeding may make written submissions on this recommendation by
.
Mental Health Court
Signature
Print name: per. Bojan Stojanovic
Date
30 October 2015
If you require further information contact
(07) 3234 0703
the Registry of the Mental Health Court on
or
Mental Health Court Registry, GPO Box 48, BRISBANE QLD 4001
To:
Director of Mental Health
Director of Public Prosecutions
Director of Forensic Disability (if applicable)
Legal Aid Queensland
Office of the Adult Guardian (if applicable)
Attorney General (FO appeals only)
Legal Representative
Nominated health practitioner
version 1
March 2002