This six-part form is an application to the Office of the Chief Provincial Psychiatrist (Director of Psychiatry) to permit a patient, who has been involuntarily admitted, to leave the Manitoba psychiatric facility in which they are being treated for a temporary period, while continuing in required psychiatric treatment.
This form is applicable toญญญญญญญญญญญ patients involuntarily admitted to a psychiatric facility in Manitoba, their attending physician or psychiatrist, and the Mental Health Review Board.
This form is processed by the attending physician/psychiatrist and the Mental Health Review Board.