Mental Health and Related Services Act 1998

Section 98

Form 49

An authorised psychiatric practitioner may order that a right of a person under sections 95, 96 and/or 97 be restricted or denied, if they reasonably believe that there is a serious likelihood of the person suffering serious physical or mental deterioration or that the safety or well-being of any other person or the general community is at risk. Where this person is an involuntary patient, the Tribunal and the person’s adult guardian must be notified.

Complete patient details or affix patient label in box below:
Full name of person:
Also known as
Date of birth:	/ /
HRN:
Sex:	☐ Male ☐ Female ☐ Non-binary ☐ Not specified
Name of Approved Treatment Facility:
Notification to the Tribunal and Adult Guardian Under the provisions of section 98 of the Mental Health and Related Services Act 1998, an order has been made for the above named person, which is a restriction or denial of entitlement. The details are:
Time:	Date:	/ /
Entitlement restricted or denied:	☐ letters ☐ postal ☐ articles ☐ telephone ☐ visitors
Grounds for restriction or denial: (attach psychiatric report for further details if required)
I have notified the person, and if appropriate, their nominated guardian, care giver and/or parent of this order. I will review the order daily and I have informed the person of their right to apply for a review.
Full name of authorised psychiatric practitioner:	Signature:	Date: / /
Form Requirements ☐ Copy sent to Tribunal and Adult Guardian ☐ Placed on clinical file