MENTAL HEALTH (CARE AND TREATMENT)
21
FORM 3
Section 10(4)
MENTAL HEALTH (CARE AND TREATMENT) ACT 2008
ORDER OF DETENTION OF A PATIENT FOR FURTHER TREATMENT
| To: | The principal officer, |
| …………………… Institution. |
I, the undersigned, ……………………………………………………………………… (here enter name and official designation) hereby certify that I on the …………… day of ……………………… 20…………… at ………………………………………… personally examined (separately from any other practitioner) ……………………………………………………………………………… (here enter name and residence of person examined) and that the said ………………………………… is mentally disordered and a proper person to be taken charge of and detained for further treatment and that I have formed this opinion on the following grounds:
STATEMENT
- 1. Facts indicating mental disorder observed by myself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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(here state the facts)
- 2. Other facts, if any, indicating mental disorder communicated to me by others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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(here state the information and from whom)
