Mental Health Act Forms

Mental Health Act

Using These Forms

See the Mental Health Act: Pathways for Examinations at a Designated Facility table for an explanation of the different processes, pathways, and examination considerations for several of the MHA forms below.

Effective July 13, 2023 any forms below marked with an * can be completed in Connect Care as a digital eForm. Any Connect Care user with the authority to complete the eForm version is encouraged to do so.

If you are not a Connect Care user, it is recommended that forms are accessed from this page as needed to avoid the risks associated with the use of outdated forms.

Government of Alberta Forms

These MHA forms can be:

• completed on the computer and then printed and signed or
• printed, then completed by hand and signed.

For best results when printing forms, use the print function at the bottom of the form.

Note: Forms may not be altered in any way.

Scheduled Maintenance

Forms are unavailable between 2:00 a.m. & 2:15 a.m. nightly for server maintenance. During this time, you will not be able to access forms.

• MH1977 Form 1 - Admission Certificate*
  • Completeness Review - Mental Health Act Admission Certificate (Form 1)
• MH1978 Form 2 - Renewal Certificate*
  • Completeness Review - Mental Health Act Renewal Certificate (Form 2)
  All Form 1s and Form 2s that ARE NOT issued as a Connect Care eForm should be reviewed for completeness using the completeness review form specific to either Form 1 or Form 2 at a Designated Facility. Please ensure your facility/zone have adopted this form for use and consult with your supervisor/manager for reporting processes.

• MH12614 Form 2.1 - Cancellation of Admission Certificate or Renewal Certificate*
• MH1979 Form 3 - Order to Return a Formal Patient to a Facility*
• MH1980 Form 4 - Certificate of Transfer into Alberta
• MH1981 Form 5 - Transfer of Formal Patient to a Jurisdiction Outside Alberta
• MH1982 Form 6 - Memorandum of Transfer to Another Facility*
• MH1983 Form 7 - Information
• MH1984 Form 8 - Warrant
• MH1985 Form 9 - Extension of Warrant
• MH1986 Form 10 - Statement of Peace Officer on Apprehension
• MH1987 Form 11 - Certificate of Incompetence to Make Treatment Decisions
• MH1988 Form 12 - Application for Review Panel Hearing
  • Note: A Form 12 must be submitted to the Review Panel Chair for the appropriate geographical area
• MH1989 Form 13 - Notice of Hearing Before Review Panel
• MH1990 Form 14 - Decision of Review Panel Regarding Mental Incompetence to Make Treatment Decisions
• MH1991 Form 15 - Decision of Review Panel Regarding Treatment
• MH1992 Form 16 - Decision of Review Panel Regarding Transfer Back to a Correctional Facility
• MH1993 Form 17 - Decision of Review Panel Regarding Admission Certificates, Renewal Certificates or Community Treatment Orders
• MH12617 Form 17.1 - Decision of Review Panel Regarding Order for the Board to Issue a Community Treatment Order
• MH1994 Form 18 - Decision of Review Panel Regarding Renewal Certificates & Community Treatment Orders (Deemed Application)
• MH2000 Form 19 - Issuance of Community Treatment Order
• MH2001 Form 20 - Renewal of Community Treatment Order
• MH2002 Form 21 - Community Treatment Orders Amendments to Community Treatment Order
• MH2003 Form 22 - Community Treatment Order Cancellation or Expiry
• MH2004 Form 23 - Community Treatment Order Apprehension Order
• MH2005 Form 24 - Community Treatment Order Examination on Apprehension
• MH2008 Form 25 - Community Treatment Order Noncompliance Report
  Update: The Community Treatment Order Written Statement form is now within Form 19, 20, & 21 and the Community Treatment Order Noncompliance Report is now Form 25