Record of Urgent Treatment - Section 62

Full Name
	
     	
Section	
     	

RiO No	
     	
Ward

Urgent treatment is to be given to the above named patient:

a)	Which is immediately necessary to save the patient’s life or:

b)	Which (not being irreversible) is immediately necessary to prevent a  serious deterioration in his/her condition or:

c)	Which (not being irreversible or hazardous), is immediately necessary to alleviate serious suffering by the patient or:

d)	Which (not being irreversible or hazardous) is immediately necessary and represents the minimum interference necessary to prevent the patient from behaving violently or being a danger to him/herself or others.

Delete the statutory criterion that does not apply.

NOTE THAT IN THE CASE OF ECT ONLY a) OR b) CAN APPLY (S58A)

Details of treatment (what is the proposed treatment and why is it immediately necessary to give the treatment?):

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Steps taken to obtain a Second Opinion Approved Doctor in compliance with Section 58(3) (b) OR Section 58A (4) or 58A (5)

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OR

Exceptional reasons for not doing so:

…………………………………………………………………………………………………...………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Signed
		Date	     	
Approved Clinician in Charge of the Treatment
	
                                   OR

Where the Approved Clinician is unable to sign this form the following should be completed:

Authority obtained from	

(BLOCK CAPS)	
On Date:	     	Time:	
am/pm	

(Explain how authority was obtained)

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Name of person completing this form………………………………………    (BLOCK CAPS)

Signature of person completing this form…………………………………………….

Date: ………………………

WHEN FULLY COMPLETED, THE ORIGINAL MUST BE HANDED TO THE MENTAL HEALTH LAW OFFICE AND A COPY ATTACHED TO THE PRESCRIPTION CHART