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This is an unofficial version . If you need an official copy, use the bilingual (PDF) version .

Note: The PDF version of the regulation does not include the prescribed form(s).

This HTML version includes links to the form(s).

As of July 8, 2026, this is the most current version available.

This is the first version. It has been in effect since October 29, 1999.

Note : Earlier consolidated versions are not available online.

Prescribed forms

Note: The PDF and HTML versions of this regulation do not include the forms prescribed by it.

The forms on this site are published only as individual files in PDF format,

but they are available in an alternate format on request.

Please contact Manitoba Government Inquiry at mgi@gov.mb.ca for more information.

Note: Each of the following is a PDF image of the prescribed form. Each form is designed to be completed as a set with the original and one or more copies to be provided to different parties. The printed form sets are available on request from the Director of Psychiatric Services.

Schedule or Form

Title

Form 1

Application for an Order for Involuntary Medical Examination

bilingual

Form 2

Order for Involuntary Medical Examination

bilingual

Form 3

Notice to Person in Custody

bilingual

Form 4

Application by Physician for Involuntary Psychiatric Assessment

bilingual

Form 5

Application by Attending Physician for Change of Patient's Status from Voluntary to Involuntary

bilingual

Form 6

Involuntary Admission Certificate

bilingual

Form 7

Renewal Certificate

bilingual

Form 8

Certificate of Change of Status to Voluntary Patient

bilingual

Form 9

Certificate of Incompetence to make Treatment Decisions

bilingual

Form 10

Certificate of Incompetence to Manage Property

bilingual

Form 11

Attending Physician's Statement that Patient in Psychiatric Facility has Regained Competence

bilingual

Form 12

Notice of Cancellation of Certificate of Incompetence

bilingual

Form 13

Request for Discharge by Voluntary Patient

bilingual

Form 14

Order for Return of Patient Absent Without Permission

bilingual

Form 15

Leave Certificate or Extension of Leave

bilingual

Form 16

Revoke or Amend Leave Certificate

bilingual

Form 17

Cancellation of Leave Certificate

bilingual

Form 18

Patient's Application to Mental Health Review Board

bilingual

Form 19

Facility's Application to Mental Health Review Board

bilingual

Form 20

Authorization of Transfer

bilingual

Form 21

Certificate of Incapacity

bilingual

Form 22

Order of Committeeship

bilingual

Form 23

Physician's Statement that Person is no Longer Incapable of Managing Property or of Personal Care

bilingual

Form 24

Notice of Cancellation of Certificate of Incapacity and Order of Committeeship

bilingual

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Mental Health Act Forms Regulation, M.R. 145/99

Règlement sur les formules applicables en matière de santé mentale, R.M. 145/99

The Mental Health Act , C.C.S.M. c. M110

Loi sur la santé mentale , c. M110 de la C.P.L.M.

Regulation 145/99

Registered October 15, 1999

bilingual version (HTML)

Règlement 145/99

Date d'enregistrement : le 15 octobre 1999

version bilingue (HTML)

Forms prescribed

1 Forms 1 to 24 are prescribed for use under The Mental Health Act .

Formules prescrites

1 Les formules 1 à 24 sont prescrites en vertu de la

Loi sur la santé mentale .

Repeal

2 Manitoba Regulation 189/91 is repealed.

Abrogation

2 Le Règlement du Manitoba 189/91 est abrogé.

Coming into force

3 This regulation comes into force on proclamation of The Mental Health and Consequential Amendments Act , S.M. 1998, c. 36.

Entrée en vigueur

3 Le présent règlement entre en vigueur en même temps que la

Loi sur la santé mentale et modifications corrélatives , c. 36 des L.M. 1998 .

October 14, 1999 Minister of Health/

14 octobre 1999 Le ministre de la Santé,

David W. Chomiak

TABLE OF FORMS

Note: Each of the following is a PDF image of the prescribed form. Each form is designed to be completed as a set with the original and one or more copies to be provided to different parties. The printed form sets are available on request from the Director of Psychiatric Services.

TABLEAU DES FORMULES

Note : Les formules réglementaires qui suivent sont accessibles sous forme d’images en format PDF. Il est prévu que chaque formule comprenne un ensemble de copies — y compris l’original — à remplir, chacune d’elles devant être remise à une

partie différente. Vous pouvez demander au directeur des Services psychiatriques de vous fournir les ensembles de formules imprimées.

Form 1 Application for an Order for Involuntary Medical Examination

Formule 1 Requête en vue de l'obtention d'une ordonnance d'examen médical obligatoire

Form 2 Order for Involuntary Medical Examination

Formule 2 Ordonnance d'examen médical obligatoire

Form 3 Notice to Person in Custody

Formule 3 Avis à la personne appréhendée

Form 4 Application by Physician for Involuntary Psychiatric Assessment

Formule 4 Demande d'évaluation psychiatrique obligatoire

Form 5 Application by Attending Physician for Change of Patient's Status from Voluntary to Involuntary

Formule 5 Demande visant le placement en cure obligatoire d'un malade en cure volontaire

Form 6 Involuntary Admission Certificate

Formule 6 Certificat d'admission en cure obligatoire

Form 7 Renewal Certificate

Formule 7 Certificat de renouvellement

Form 8 Certificate of Change of Status to Voluntary Patient

Formule 8 Certificat de changement de statut

Form 9 Certificate of Incompetence to make Treatment Decisions

Formule 9 Certificat d'incapacité mentale de prendre des décisions liées au traitement

Form 10 Certificate of Incompetence to Manage Property

Formule 10 Certificat d'incapacité de gérer des biens

Form 11 Attending Physician's Statement that Patient in Psychiatric Facility has Regained Competence

Formule 11 Déclaration du médecin traitant indiquant que le malade d'un établissement psychiatrique a retrouvé sa capacité mentale

Form 12 Notice of Cancellation of Certificate of Incompetence

Formule 12 Avis d'annulation du certificat d'incapacité

Form 13 Request for Discharge by Voluntary Patient

Formule 13 Demande de congé d'un malade en cure volontaire

Form 14 Order for Return of Patient Absent Without Permission

Formule 14 Ordre visant le retour du malade qui s'est absenté de l'établissement sans permission

Form 15 Leave Certificate or Extension of Leave

Formule 15 Certificat d'autorisation ou prorogation du certificat d'autorisation

Form 16 Revoke or Amend Leave Certificate

Formule 16 Révocation ou modification du certificat d'autorisation

Form 17 Cancellation of Leave Certificate

Formule 17 Annulation du certificat d'autorisation

Form 18 Patient's Application to Mental Health Review Board

Formule 18 Demande d'un malade à la Commission d'examen des questions liées à la santé mentale

Form 19 Facility's Application to Mental Health Review Board

Formule 19 Demande d'un médecin traitant ou d'un directeur médical à la Commission d'examen des questions liées à la santé mentale

Form 20 Authorization of Transfer

Formule 20 Autorisation de transfert

Form 21 Certificate of Incapacity

Formule 21 Certificat d'incapacité

Form 22 Order of Committeeship

Formule 22 Ordre de nomination du curateur public

Form 23 Physician's Statement that Person is no Longer Incapable of Managing Property or of Personal Care

Formule 23 Déclaration du médecin indiquant qu'une personne n'est plus incapable de gérer ses biens ou de s'occuper de ses soins personnels

Form 24 Notice of Cancellation of Certificate of Incapacity and Order of Committeeship

Formule 24 Avis d'annulation du certificat d'incapacité et de l'ordre de nomination du curateur public