After conducting an involuntary psychiatric assessment, a psychiatrist on the staff of a Nova Scotia facility uses this declaration to admit the person as an involuntary inpatient. It records the examination dates and methods, all five section 17 criteria including lack of capacity to make admission and treatment decisions, the reasons and sources relied on, and an expiry date no more than 30 days away.
The psychiatrist who conducted the involuntary psychiatric assessment completes and signs the declaration, names the psychiatric facility and checks a box confirming the patient and substitute decision-maker were told of the right to legal counsel.
Download the current version from the source each time; forms change without notice.
Form 4 - Declaration of Involuntary Admission
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Clause 22(a) of the Act allows detention, observation and examination for not more than 30 days under a declaration of involuntary admission. The psychiatrist enters an expiry date on the form no later than 30 days after the date signed; continuing requires a Form 5 renewal.
The chief executive officer must examine the declaration immediately, deliver a copy to the patient and substitute decision-maker, and promptly inform them in writing of the reasons for admission, the Review Board's function, the right to apply for review, the right to counsel and the other section 26 rights.
The province's forms page posts the IPTA forms in English only. French versions are offered for the factsheets explaining the Act, the Review Board, the Patient Rights Advisory Service and substitute decision-makers, not for the forms themselves.