A physician uses this one-page Mental Health Act certificate to end a Yukon patient's involuntary status. After examining the patient, the physician states that the person is not, or is no longer, suffering from a mental disorder likely to cause serious bodily harm or substantial mental or physical impairment without involuntary admission, and revokes the Form 7 or Form 11 certificates in effect.
The physician who examined the patient records the date and time of the examination, then dates and signs the certificate; section 17(2) of the Act assigns the change of status to the attending physician.
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Form 12 - Certificate of Change of Status
Formulaire 12 - Certificat de changement de statut
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When the attending physician believes an involuntary patient no longer meets the section 13(1) criteria but does meet the criteria for voluntary admission, before the current certificate runs out. Completing and filing Form 12 revokes the Form 7 or Form 11 then in effect and changes the patient's status to voluntary.
The form lists four recipients: the Capability and Consent Board, the Chief Executive Officer of Whitehorse General Hospital, the patient, and the next of kin, proxy or guardian if one is available. Section 17(2) of the Act also requires filing with the person in charge of the hospital.
Yes. Yukon posts Formulaire 12, Certificat de changement de statut, on its French forms page alongside the English version. Both are one-page fillable PDFs; the English edition is dated July 2019 and the French edition September 2019.