Cto 2 Form – Fill Out and Use This PDF

The following form is to be used:

where as part of the application process for a compulsory treatment order, two medical practitioners are required to carry out medical examinations of the patient.

An approved medical practitioner MUST complete one of these reports. The patient's general medical practitioner may carry out one of the examinations and complete the second report.

There is no statutory requirement that you use this form but you are strongly recommended to do so. This form draws attention to some procedural requirements under the Mental Health (Care and Treatment) (Scotland) Act 2003. Failure to observe procedural requirements may invalidate the report.

If you are not completing this form electronically, please observe the following conventions, to ensure accuracy of information:

Where a text box has a reference number to the left, you can extend your response on plain paper where there is insufficient space in the box. Extension sheet(s) should be clearly labelled with Patient's name and CHI number, and each extended response should be labelled with the appropriate text box reference number.

Patient Details

CHI Number

Surname

First Name (s)

Other / Known As

'Other / Known As' could include any name / alias that the patient would prefer to be known as.

Medical Practitioner Details

Note: Where an examination is conducted jointly, both medical practitioners MUST complete a separate mental health report.

Surname

First Name

Title

Address

Postcode

Telephone e-mail address

To be completed by the Medical Practitioner

Medical Practitioner Details (cont)

Complete A or B as appropriate

A I, the medical practitioner named on page 1, am approved under section 22 of the Act by:

Health Board NHS as having special experience, qualifications and training in the diagnosis and treatment of mental disorder. My GMC number is:

OR

Please state how well you know the patient

1

I certify that I have no conflict of interest as defined by the regulations

Details Of Examination

Complete A or B as appropriate

A separately from the other medical practitioner providing a mental health report

OR

Bas a joint examination in the company of:

Name

of other medical practitioner

The patient consented to a joint examination, OR

as the patient is incapable of consenting to a joint examination, consent for this joint examination was provided prior to the examination taking place, by:

i) the patient's named person(as nominated under section 250 to 253 of the Act);

ii) the guardian (see Notes), who is authorised to provide consent under the 2000 Act;

iii) the welfare attorney (see Notes), who is fully authorised to provide consent under the 2000 Act

Name

of person providing consent

Notes

"Guardian" means a person appointed as a guardian under the Adults with Incapacity (Scotland) Act 2000 (asp 4) who has power by virtue of section 64(1)(a) or (b) of that Act in relation to the personal welfare of a person, where they have the power to consent

"Welfare attorney" means an individual authorised, by a welfare power of attorney granted under section 16 of the Adults with Incapacity (Scotland) Act 2000 (asp 4) and registered under section 19 of that Act, to act as such, where they have the power to consent

To be completed by the Medical Practitioner

Diagnosis Of Mental Disorder

The patient has the following type(s) of mental disorder (see notes below) -

Primary ICD 10 Code

Please provide a description of the symptoms that the patient has of this/these mental disorder(s) and of the ways in which the patient is affected by them.

2

Details Of Medical Treatment Proposed

I am satisfied, for the reasons stated below, that if the patient were not provided with treatment there would be a significant risk:

to the patient's health, safety or welfare

to the safety of any other person

3

Notes

As detailed in section 328 (2) of the Act, a person is not mentally disordered by reason only of any of the following: sexual orientation; sexual deviancy; transsexualism; transvestism; dependence on, or use of, alcohol or drugs; behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person; acting as no prudent person would act.

For a compulsory treatment order application to be able to proceed, this mental health report must specify at least one type of mental disorder which is specified in the other mental health report

To be completed by the Medical Practitioner

Notice To Patient

This section should only be completed where an AMP is completing the form. Where two AMPs are providing the mental health report, it would be best practice for the patient's RMO to complete this section.

I believe that (shade as appropriate):

notice of the compulsory treatment order application should be given to the patient by the MHO under section 60(1)(a) of the Act

OR

notice of the compulsory treatment order application should NOT be given to the patient by the MHO under section 60(1)(a) of the Act; as, in my opinion, the giving of that notice would be likely to cause significant harm to the patient or another person

AND

the patient IS capable of instructing a solicitor in relation to the application under section 63 of this Act

OR

the patient IS NOT capable of instructing a solicitor in relation to the application under section 63 of this Act

Please explain your reasons for coming to these conclusions:

7

Other Relevant Information

8

Signature / Date

Notes

Under Section 58 of the Act, the latter of the two medical examinations must be completed no more than 5 days after the first

the MHO is required under Section 57(7) of the Act to make the application for the compulsory treatment order within 14 days of the second medical examination being conducted.