New South Wales Consolidated Acts

MENTAL HEALTH (FORENSIC PROVISIONS) ACT 1990 - SCHEDULE 2

SCHEDULE 2 – Medical certificate as to examination of inmate

(Section 55 (2))

Mental Health (Forensic Provisions) Act 1990

I, [name in full-use block letters] (*Medical Practitioner/Psychiatrist) ofdo hereby certify that on the [date] at [state name of correctional centre where examination took place] separately from any other medical practitioner, I personally examined [name of inmate in full] and I am of the opinion that *he/she is *a mentally ill person/suffering from a mental condition for which treatment is available in a mental health facility.

I have formed this opinion on the following grounds:

(1) Facts indicating *mental illness/mental condition observed by myself.

(2) Other relevant information (if any) communicated to me by others (state name and address of each informant).

Made and signed this [date]

[Signature]

*Delete whichever does not apply.