Appendix 15 MENTAL HEALTH ACT DOCUMENT SCRUTINY CHECKLIST NOTE: scrutiny should happen at the same time as the documents “This are received or as soon as possible afterwards (and certainly no later than the next working day)”. Section 20A Forms: CT07 Community Treatment Order report extending the – – community treatment period Patient’s Name: Date Of CTO: Part 1 Do you have the correct form for the extension Yes ☐ □ No of the CTO? Has the form been made out to the managers Yes ☐ □ No of the *responsible hospital? (*name and address of the hospital where the patient was before the CTO was made)? Note: (*unless responsibility was subsequently assigned to the managers of a different hospital) Yes No □ ☐ Has the RC completing the form entered their name and address on the form? Yes No ☐ Has the full name and address of the patient □ been entered on the form? Yes No ☐ Has the correct date the CTO was made been □ entered on the form? Has the person providing the report given Yes ☐ □ No reasons why it appears to them that an application ought to be made including why informal admission is no longer appropriate? Yes No □ ☐ Has the RC entered the date of examination on the form? Yes No ☐ Is the date of examination within 2 months of the □ date the CTO would expire if not renewed? Yes No ☐ Has the RC entered the reasons for his/her □ opinion that the patient is suffering from a mental disorder of a nature or degree which makes it appropriate for the pt to receive medical treatment as a CTO patient? Yes No ☐ Has part 1 of the form been signed and dated by □ the RC? No Is the date of the RCs signature prior to the date Yes ☐ ☐ the CTO would expire if not extended?
Appendix 15 MENTAL HEALTH ACT DOCUMENT SCRUTINY CHECKLIST NOTE: “This scrutiny should happen at the same time as the documents are received or as soon as possible afterwards (and certainly no later than the next working day)”. Section 20A Forms: CT07 – Community Treatment Order – report extending the community treatment period Patient’s Name: Date Of CTO: Part 1 Do you have the correct form for the extension of the CTO? □ Yes ☐ No Has the form been made out to the managers of the *responsible hospital? (*name and address of the hospital where the patient was before the CTO was made)? Note: (*unless responsibility was subsequently assigned to the managers of a different hospital) □ Yes ☐ No Has the RC completing the form entered their name and address on the form? □ Yes ☐ No Has the full name and address of the patient been entered on the form? □ Yes ☐ No Has the correct date the CTO was made been entered on the form? □ Yes ☐ No Has the person providing the report given reasons why it appears to them that an application ought to be made including why informal admission is no longer appropriate? □ Yes ☐ No Has the RC entered the date of examination on the form? □ Yes ☐ No Is the date of examination within 2 months of the date the CTO would expire if not renewed? □ Yes ☐ No Has the RC entered the reasons for his/her opinion that the patient is suffering from a mental disorder of a nature or degree which makes it appropriate for the pt to receive medical treatment as a CTO patient? □ Yes ☐ No Has part 1 of the form been signed and dated by the RC? □ Yes ☐ No Is the date of the RCs signature prior to the date ☐ Yes the CTO would expire if not extended? ☐ No
MHA-PGN-08-App15-Clist-Sec20A-ExtCTO-V01-Iss1-IssFeb16.docx