A physician, nurse practitioner or other qualified health professional issues this certificate within 24 hours of examining someone who meets all four admission criteria of Alberta's Mental Health Act. One certificate authorizes conveyance to a designated facility and 24 hours of detention there for a second examination. A second Form 1 within those 24 hours makes the person a formal patient for one month.
The examining qualified health professional completes the whole certificate, ticking whether they are a physician or another qualified health professional. Of the two certificates needed for formal patient status, section 7 requires at least one to be issued by a physician and at least one by a member of the facility's staff.
Download the current version from the source each time; forms change without notice.
Form 1 - Admission Certificate
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Yes. Section 2 of the Mental Health Act lets any qualified health professional issue an admission certificate, and the Act defines that term to include a physician or nurse practitioner. For formal patient status, though, at least one of the two certificates must come from a physician and at least one from a member of the facility's staff.
It must be issued within 24 hours of the examination. One certificate allows conveyance to a facility within 72 hours of issue and detention for 24 hours after arrival. If a second certificate is not issued in that time, the person is released or may stay voluntarily; two certificates authorize detention for one month from the second.
It checks the issuer's name, business address and type, the person's name, the examination date, time, means and location, facts for all four criteria with their source marked, the conveyance facility when issued outside a designated facility, the issue date and time, and the signature. Gaps go to the most responsible qualified health professional.