When an involuntary patient's Certificate of Involuntary Admission or existing Certificate of Renewal is expiring, the attending physician uses this Mental Health Act form to renew their involuntary status in an Ontario psychiatric facility. The physician records the date of examination and the expiry of the current certificate, and completes Box A, Box B or both. The renewal takes effect on signing, and the physician enters its expiry date.
The attending physician completes and signs the certificate after examining the patient, and the patient is given a Form 30 notice with the renewal.
Download the current version from the source each time; forms change without notice.
Form 4 - Certificate of Renewal
Formule 4 - Certificat de renouvellement
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When an involuntary patient's current certificate, either the Certificate of Involuntary Admission (Form 3) or an earlier Certificate of Renewal, is expiring and the attending physician is of the opinion that the criteria are still met. The renewal is effective on signing and runs to the expiry date entered.
Box A requires a mental disorder likely to result in serious bodily harm to the patient or another person, or serious physical impairment, unless the patient remains in custody, plus unsuitability for informal or voluntary status. Box B mirrors Form 3's criteria for patients incapable of consenting to treatment, with a sixth criterion on unsuitability.
Yes. The French version, Formule 4, Certificat de renouvellement, is posted as form 3774-41 in Ontario's Central Forms Repository, alongside the English 6430-41 (00/12) edition, so the renewal can be completed in either official language.