Form 3e - Order That Person Cannot Continue To Be Detained

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Please use ID label or block print
CHIEF PSYCHIATRIST
FAMILY NAME
UMRN
OF
GIVEN NAMES
CMHI
WESTERN AUSTRALIA
BIRTHDATE
GENDER
WA MENTAL HEALTH
ACT 2014
ADDRESS
SECTION: 72
FORM 3E – ORDER THAT PERSON CANNOT CONTINUE TO BE DETAINED
Reasons for making order:
 I have examined the person and am satisfied that the person does not need to continue to be
detained.
Any comments (optional):
 Yes
 No
Is the person being admitted as a voluntary inpatient:
Name of psychiatrist making this order:
_________________________________________
Qualifications: ________________________________________________________________
Signature: ___________________________________________________________________
Date and time order made:
Date:
DD/MM/YY
Time
HH:MM
:
March 2016

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