Form 32 "Application for Confidentiality Order" - Queensland, Australia

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MENTAL HEALTH COURT
Application for Confidentiality Order
Mental Health Act 2000 Queensland
Section 426
The person the subject of
Personal details
the Mental Health Court
Given name/s
Family name
proceeding
Confidentiality Order
 The Court may make a confidentiality order in respect of:
a) information given before it;
b) matters contained in a document or part of a document;
c) its reasons for a decision;
d) reasons for taking into account or refusing to take into account material
submitted under section 284(1);
e) if the material submitted under section 284(1) was taken into account – how the
material was taken into account.
A confidentiality order will prohibit or restrict the disclosure of that material to the
person the subject of the proceedings.
Before making a confidentiality order the Court must be satisfied that the
disclosure of the information would:
a) cause serious harm to the health of the person; or
b) put the safety of someone else at serious risk.
If a confidentiality order is made the information or matters withheld must be
disclosed to the lawyer/agent of the person concerned and written reasons must be
given to the lawyer/agent
Outline the specific
Documents and/or information to remain confidential
document/s or
information for which a
Confidentiality Order is
sought
If material is part of a
document indicate
clearly that part of the
document which is the
subject of application
see over for additional space
Outline the reasons
Basis of the request for a Confidentiality Order
for which the
Confidentiality Order
is sought
Specify how the
disclosure of the
information would:
 cause serious harm
to the health of the
person; or
 put the safety of
someone else at
serious risk
see over for additional space
Details of person making request
Tick  applicable
Victim
Reporting Doctor
box
Other (specify)__________________________________________________________________
Do you wish to amend or withdraw your submission if a Confidentiality Order is not
made?
Yes
No
(If you withdraw your submission it will be returned to you.)
Print name
Signature
Date
/
/
MENTAL HEALTH COURT
Application for Confidentiality Order
Mental Health Act 2000 Queensland
Section 426
The person the subject of
Personal details
the Mental Health Court
Given name/s
Family name
proceeding
Confidentiality Order
 The Court may make a confidentiality order in respect of:
a) information given before it;
b) matters contained in a document or part of a document;
c) its reasons for a decision;
d) reasons for taking into account or refusing to take into account material
submitted under section 284(1);
e) if the material submitted under section 284(1) was taken into account – how the
material was taken into account.
A confidentiality order will prohibit or restrict the disclosure of that material to the
person the subject of the proceedings.
Before making a confidentiality order the Court must be satisfied that the
disclosure of the information would:
a) cause serious harm to the health of the person; or
b) put the safety of someone else at serious risk.
If a confidentiality order is made the information or matters withheld must be
disclosed to the lawyer/agent of the person concerned and written reasons must be
given to the lawyer/agent
Outline the specific
Documents and/or information to remain confidential
document/s or
information for which a
Confidentiality Order is
sought
If material is part of a
document indicate
clearly that part of the
document which is the
subject of application
see over for additional space
Outline the reasons
Basis of the request for a Confidentiality Order
for which the
Confidentiality Order
is sought
Specify how the
disclosure of the
information would:
 cause serious harm
to the health of the
person; or
 put the safety of
someone else at
serious risk
see over for additional space
Details of person making request
Tick  applicable
Victim
Reporting Doctor
box
Other (specify)__________________________________________________________________
Do you wish to amend or withdraw your submission if a Confidentiality Order is not
made?
Yes
No
(If you withdraw your submission it will be returned to you.)
Print name
Signature
Date
/
/
To:
Mental Health Court Registry
GPO BOX 48,
BRISBANE QLD 4001
Additional space if required
Documents and/or Information to remain confidential
continued
Basis of the request for a Confidentiality Order
continued
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