human rights and legislation who resource book on mental health

I base my opinion on the following facts
FACT/S PERSONALLY OBSERVED BY ME ON EXAMINATION
FACTS COMMUNICATED TO ME BY ANOTHER PERSON
TO BE COMPLETED WHERE NO FACTS ARE PERSONALLY OBSERVED
As no facts were personally observed by me, the following facts were communicated
directly to me *in person/in writing/by telephone/by electronic communication by
Dr
GIVEN NAME(S)/FAMILY NAME (BLOCK LETTERS) of other registered medical practitioner
of
doctor's address
doctors telephone number
<strong>who</strong> examined the above named person on (date)
(being a period not more than 28 days prior to today's date)
FACTS COMMUNICATED BY OTHER EXAMINING REGISTERED MEDICAL PRACTITIONER:
I consider that the above named person should be admitted to an approved mental health
service.
GIVEN NAME(S)/FAMILY NAME (BLOCK LETTERS)
of recommending registered medical practitioner
signed
SIGNATURE of recommending registered medical practitioner
Qualifications:
Address
Telephone number
*circle as necessary
date
(See: http://www.dms.dpc.vic.gov.au/Domino/Web_Notes/LDMS/PubLawToday.nsf?OpenDatabase)
Excerpts from <strong>legislation</strong> of the Parliament of the State of Victoria, Australia, are reproduced
with permission of the Crown in right of the State of Victoria, Australia. The State of
Victoria accepts no responsibility for the accuracy <strong>and</strong> completeness of any <strong>legislation</strong> in
this publication.
176