Section 17F (4) (only complete where CTO is revoked) Forms: CT05 Revocation of community treatment order – Patient’s Name: Date Of Section: Part 1 Do you have the correct form for the Yes No section? Has the RC entered their full name and Yes No address? Is the full name and address of the patient Yes No completed? Is the name and address of the hospital Yes No the patient is detained completed? Has The RC entered the reasons for his Yes No opinion? Has the RC signed and dated part 1 of the Yes No form? Is the date within the 72 hour recall period? Yes No Part 2 Has the AMHP completing Part 2 entered Yes No their full name and address? Has the AMHP entered the name of the authority on whose behalf they are acting? Yes No Where the AMHP is not approved by that authority (above) have they entered the Yes No name of the local authority that approved them (and made the necessary deletion)? Has the AMHP signed and dated Part 2 of Yes No the form? Is the date within the 72 hour recall period Yes No and on or the date of Part 1? Part 3 Is the time and date (indicating the time/date the patient was detained in Yes No hospital having been recalled) the same time/date as that entered on the CTO4 detailing that event? Has the RC signed and dated the form (and is date within 72 hour period)? Yes No Please complete following scrutiny Name of person Date of scrutiny Signature carrying out scrutiny
Section 17F (4) (only complete where CTO is revoked) Forms: CT05 – Revocation of community treatment order Patient’s Name: Date Of Section: Part 1 Do you have the correct form for the section? Yes No Has the RC entered their full name and address? Yes No Is the full name and address of the patient completed? Yes No Is the name and address of the hospital the patient is detained completed? Yes No Has The RC entered the reasons for his opinion? Yes No Has the RC signed and dated part 1 of the form? Yes No Is the date within the 72 hour recall period? Yes No Part 2 Has the AMHP completing Part 2 entered their full name and address? Yes No Has the AMHP entered the name of the authority on whose behalf they are acting? Yes No Where the AMHP is not approved by that authority (above) have they entered the name of the local authority that approved them (and made the necessary deletion)? Yes No Has the AMHP signed and dated Part 2 of the form? Yes No Is the date within the 72 hour recall period and on or the date of Part 1? Yes No Part 3 Is the time and date (indicating the time/date the patient was detained in hospital having been recalled) the same time/date as that entered on the CTO4 detailing that event? Yes No Has the RC signed and dated the form (and is date within 72 hour period)? Yes No Please complete following scrutiny Name of person carrying out scrutiny Date of scrutiny Signature