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Manitoba MHA Form 6: Involuntary Admission Certificate

A psychiatrist completes this Manitoba Mental Health Act certificate after examining a person brought in on an application for involuntary psychiatric assessment and deciding to admit them as an involuntary patient. It records the examination date, the criteria met, a diagnosis or provisional diagnosis and the supporting facts, and authorizes detention and treatment in the facility for up to 21 days.

Who completes it

The examining psychiatrist completes and signs the whole certificate. If a psychiatrist made the original application, a different psychiatrist must conduct the assessment and sign this certificate.

Submitting and payment

How to submit it
The certificate is filed with the medical director, who must promptly check that it was completed in accordance with the Act. The printed copy line sends the original to the medical director and copies to the chart and the Director of Psychiatric Services.

Good to know

  • The form requires all three criteria: a mental disorder likely to cause serious harm or substantial deterioration, a need for continuing treatment reasonably available only in a facility, and inability to be admitted voluntarily.
  • The psychiatrist enters a diagnosis or provisional diagnosis and separates facts they observed from facts communicated by others, as subsection 18(2) of the Act requires.
  • A person held on an application must be released within 72 hours of first being detained in the facility unless they are admitted as a patient within that time.
  • Before the 21 days end, the attending psychiatrist must reassess the patient and complete a Form 7 Renewal Certificate if the requirements continue to be met.

Get the official form

Download the current version from the source each time; forms change without notice.

Form 6 - Involuntary Admission Certificate

Formule 6 - Certificat d'admission en cure obligatoire

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

How long does a Manitoba Involuntary Admission Certificate last?

Section 19 of the Act, reproduced in the form's notes, makes the certificate authority to detain, restrain, observe, examine and treat an involuntary patient in a facility for not more than 21 days from the date of the certificate. Continuing beyond that requires a Form 7 Renewal Certificate.

What options does the assessing psychiatrist have?

After examining the person and assessing their mental condition, the psychiatrist must do one of three things under subsection 16(3): admit the person as a voluntary patient, admit them as an involuntary patient by completing Form 6, or release them under section 20.

Who is told about an involuntary admission?

The medical director must promptly inform the patient in writing of the admission, the right to apply to the Mental Health Review Board and the right to retain and instruct counsel. Unless a mentally competent patient objects, the person who would make treatment decisions on their behalf is also informed.