Forms
The chair of the Capability and Consent Board fills out this form after they review form 13. Form 13 is the notice of intention to transfer an involuntary patient who's a Yukon resident. This determines if the chair recommends transferring... more
A physician fills out this form when they plan to transfer an involuntary patient to another facility. This form is for Yukon residents.
Fill out this form if you've been an involuntary patient and are capable to waive the right to a hearing. Give a copy of this form to the Capability and Consent Board.
The attending physician and 1 other physician will each fill out this form to determine if a patient is in need of care. This form must filled out within 24 hours of a patient's involuntary admission.
Fill out this form to allow the hospital to share your clinical record with another person. Give a copy to the chief executive officer of the hospital and a physician.
Fill out this form if you disagree with facts on your clinical record. Give a copy to: the chief executive officer of the hospital; a physician; and anyone who's received copies of your clinical record in the last year.
Fill out this form if you believe there's an error on your clinical record and you'd like it corrected. Give a copy to the chief executive officer of the hospital and a physician.
A physician fills out this form when a patient on temporary release refuses to return to the hospital. The chief executive officer of the hospital, RCMP and the patient get a copy.
A physician fills out this form to grant temporary release of an involuntary patient. The chief executive officer of the hospital must sign this and give a copy to the patient.
A physician fills out this form to transfer an involuntary patient to another facility. This form is for non-residents of Yukon. The director of Insured Health Services and the chief executive officer of the hospital get a copy.
The chief executive officer of the hospital fills out this form. It notifies a patient that they are, or continue to be, an involuntary patient at the hospital.
Fill out this form if you or someone you know is an involuntary patient and wants to appeal a certificate. Give a copy of this form to the Capability and Consent Board.
The attending physician and 1 other physician will each fill out this form if they want to extend care for an involuntary patient. The physicians give copies to the Capability and Consent Board and the chief executive officer of the... more
A physician fills out this form to revoke a patient's involuntary status. The physician gives a copy to: the Capability and Consent Board; the chief executive officer of the hospital; the patient; and 1 of their relatives.
A nurse fills out this form after they finish a patient's mental health examination.
A physician fills out this form if a patient is unable to consent to 3 months or longer of needed chemotherapy. This is a request for authorization from the Capability and Consent Board.
Fill out this application if you believe another person suffers from a mental disorder per the Mental Health Act and want them examined. You have to submit this form to a judge. The judge must sign this form and decide if they'll issue an... more
A judge fills out this form if they believe there's a reason to apprehend a person under section 6(3) or 7(1) of the Mental Health Act. The judge gives the completed form to: the RCMP; the Capability and Consent Board; the person... more
A peace officer fills out this form if they apprehend a person under section 6(1) or 8(2) of the Mental Health Act. The officer gives a copy of this form to the Capability and Consent Board and a physician.
The chief executive officer of the hospital fills out this application form. It requests a patient's clinical record be withheld. A clinical record can be withheld if it's damaging to the patient or another named person. The chief... more
Fill out this form if you have custody of a child under the age of 16 who wants to change their gender on their birth certificate. Give this form to Vital Statistics.
Fill out this form to change the gender on your birth certificate. You must be 16 years old or over to fill out this form. Give this form to Vital Statistics.
Complete the emergency health information form if you have special health care needs. This way, health care providers have your medical information during an emergency.
Use this form to apply for social assistance. The information you provide will determine your eligibility. You have to apply for social assistance each month. You can apply 1 month in advance. For example, if you need social assistance in... more
If you receive social assistance, you can use this form to ask for a household allowance. It covers items such as: household equipment and supplies; furniture; appliances; and specialty items.