Form C - Warrant To Apprehend printable pdf download

M-13.1 REG 1

MENTAL HEALTH SERVICES

FORM C

Warrant to Apprehend

[Subsection 19(2) of The Mental Health Services Act]

CANADA

PROVINCE OF SASKATCHEWAN

To all or any of the peace officers in Saskatchewan or to __________________________ :

(name of other person

directed to execute warrant)

WHEREAS information has been laid before me, the undersigned, a Judge of the

Provincial Court of Saskatchewan, that:__________________________________________

(name in full of person who is the subject of this warrant)

of ____________________________________________________________________________

(residence)

refuses to submit to a medical examination and is believed to be suffering from a mental

disorder and is in need of examination to determine whether he or she should be admitted

to a mental health centre pursuant to section 24 of The Mental Health Services Act;

AND WHEREAS I have made sufficient inquiry to satisfy myself that ______________

(name in full of person who is

the subject of this warrant)

is in need of the examination on the following grounds: ___________________________

_______________________________________________________________________________

______________________________________________________________________________ ;

AND WHEREAS I have made arrangements with ____________________ , a physician

(name of physician)

who has admitting privileges to _____________________________________________ , in

(name of mental health centre)

order that an examination may be made.

THIS IS THEREFORE TO COMMAND you or any of you in Her Majesty’s Name

forthwith to apprehend _________________________________________________________

(name of person who is the subject of this warrant)

and convey him/her to _________________________________________________________

(place/location)

in order that an examination may be made.

AND FOR WHAT SHALL BE DONE in the premises by the peace officers or ________

_______________________________________________________________________________

(name of other person who is directed to execute warrant)

and the physician mentioned above, this shall be sufficient warrant authority.

Given under my hand and seal this ____ day of ________________ , , _______ at ______

in Saskatchewan.

_____________________________________________

Judge of the Provincial Court of Saskatchewan

Form C - Warrant To Apprehend