Mental Health and Wellbeing Act 2022 forms

Forms to support the implementation of the Mental Health and Wellbeing Act 2022.

11 August 2023
Duration:: 0:49

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The department has developed the following forms to support the implementation of the Mental Health and Wellbeing Act 2022 (the Act). .

Services can download and print forms from the website or order hard copies of selected forms from Allanby Press Printers.

The MHWA125 notice of death form is available on the Chief Psychiatrist’s website.

Assessment Order forms

MHWA 101 Assessment Order

MHWA 102 Receipt of person subject to Inpatient Assessment Order

MHWA 103 Variation of Assessment Order

MHWA 104 Extension of Assessment Order

MHWA 105 Revocation of Assessment Order

MHWA 106 Variation of Court Assessment Order

Temporary Treatment Order and Treatment Order forms

MHWA 110 Temporary Treatment Order

MHWA 111 Variation of Temporary Treatment Order or Treatment Order

MHWA 112 Revocation of Temporary Treatment Order or Treatment Order

MHWA 113 Application for another Treatment Order

MHWA 114 Application to Mental Health Tribunal

Operational forms (leave, transfer etc)

MHWA 120 Leave of absence for compulsory patient

MHWA 122 Revocation of leave of absence for compulsory patient

MHWA 123 Transfer of a compulsory patient to another designated mental health service

MHWA 124 Information to support transport and/or care and control of a patient absent without leave

MHWA 126 Information to support transport and/or care and control of a patient on a varied order

MHWA 130 Substitute consent to medical treatment by authorised psychiatrist

MHWA 131 Informed consent to ECT

MHWA 131A Informed consent to ECT by medical treatment decision maker

MHWA 132 Application for electroconvulsive treatment (ECT)

MHWA 132A Application for ECT - Voluntary Adult without capacity to consent

Restrictive interventions

MHWA 144 Right to restrict communication

Updated 27 Aug 2025

MHWA 145 Authority for use of restrictive Interventions

MHWA 145A Restrictive Interventions Observations (Continuation)

Guidelines regarding the use of chemical restraint are published by the Office of the Chief Psychiatrist.

Security and forensic patients

MHWA 150 Receipt of security or forensic patient

MHWA 151 Leave of absence for security patient

MHWA 153 Revocation of leave of absence for security patient

MHWA 154 Special leave of absence for forensic patient

MHWA 155 Application for monitored leave for security patient

MHWA 156 Transfer of security or forensic patient

MHWA 157 Discharge of security patient

MHWA 158 Report of psychiatrist

MHWA 159 Report of authorised psychiatrist

Cross border

MHWA 170 Interstate transfer of compulsory patient with consent

MHWA 171 Interstate transfer of compulsory patient without consent

Admissions, registration and separations

MHWA PR 1 Registration - Demographics

MHWA PR 1a Registration - Legal and clinical

MHWA PR 2 Admission

MHWA PR 5 Separation

Advance statement of preferences

Forms for making or revoking an advance statement of preferences are on the advance statement of preferences page.

If a psychiatrist makes a treatment decision that is not in accordance with the person’s advance statement of preferences, they must provide a written explanation to IMHA as soon as practicable but no later than 10 business days after the decision has been made.

This form supports psychiatrists to comply with the requirements under the Mental Health and Wellbeing Act 2022.

Nominated support persons

Forms for nominating a nominated support person or revoking a nomination can be found on the nominated support persons page.

Access to archived mental health information

Access to archived mental health information held by the Department of Health can be requested through Freedom of Information or via email at foi@health.vic.gov.au

Updated 29 June 2026