Instructions for completing Monthly Rights Advice Data Form
NOTE: The Personal Health Information Protection Act will become law on November 1, 2004. Please note that some Forms will be revoked and others will change as a result. Revised information will be posted after November 1, 2004.
Completion of Form:
The Monthly Rights Advice Data Form should be completed monthly and forwarded
to the Psychiatric Patient Advocate Office by the 15th of the following month.
Identification Section:
Complete identifying information for facility as well as month/year for statistics.
Rights Advice Situation:
Each mandatory rights advice situation must be included in the appropriate category.
For example, Form 3, Form 4, etc.
First Contact (Col. A):
This section records the first contact with a person on a given rights advice situation.
For example, Mr. Smith is seen on Form 3 and treatment incapacity. This is recorded
under first contact for each of the Form 3 and the treatment incapacity. If Mr. Smith
is visited on the same Form 3 in one month and also in the subsequent month, the visit
in the second month would be recorded as a second, third or subsequent contact.
THE CONTACTS ARE BASED UPON THE FORM AND NOT UPON THE MONTH.
Second Contact (Col. B):
This section records each second contact on each rights advice situation. For example,
Mr. Smith was seen a second time as there was a question as to his level of
understanding. The visit is recorded as a second contact.
Third and Subsequent Contacts (Col. C):
Each third and subsequent contact is recorded for each rights advice situation.
For example, Mr. Smith is visited on a third occasion regarding the same Form 3.
The visit is recorded under Form 3.
Application to the CCB (Col. D):
Record the number of applications to the Consent and Capacity Board for each
rights advice situation.
Rights Advice Duration (Col. E and F):
This section records the number of times it took more or less than thirty minutes
to perform the rights advice function. The rights advice function includes
visiting the client, assisting with applications to the CCB, assisting with a
Legal Aid application, and assisting the client to obtain a lawyer. Each first,
second or third and subsequent contacts will be recorded as being over or under
thirty minutes in duration. For example, you saw Mr. Smith on the Form 3 for
forty minutes on the first occasion, twenty minutes on the second and fifty minutes
on the third. This would be recorded under Form 3 as one less than thirty minutes
and two more than thirty minutes.
CCB Hearing (Col. G and H):
Yes (Col. G):
This section is completed if the client applied for a hearing. If a hearing took
place, you complete the section "Outcome of Hearing Patient Successful" indicating
whether the client was successful at the hearing.
No (Col. H):
This section is completed if the client applied for a hearing but a hearing did
not take place. In this case, you complete the section "Reason No Hearing Held".
Outcome of Hearing - Patient Successful (Col. I and
J):
This section is completed if a CCB hearing is held to indicate the outcome of the
hearing.
Reason No Hearing Held (Col. K, L and M):
This section is completed if the client applied for a CCB hearing but a hearing
was not held. It records the reasons a hearing was not held.
Physician Changed Status:
This section records hearings which are not held on Forms 3 and 4 because the
physician changed the patient's status to voluntary (Form 5).
Client Withdrew:
This section records the hearings, which are not held because the client withdrew
the application. This applies to all the rights advice situations.
Other:
This applies to all other reasons for a hearing not being held. For example, the
client was discharged before the hearing was held or the hearing was adjourned.
It would also apply if an application was made but the hearing was pending.
Please remember to record pending hearings once held.
Totals:
Each column should be totalled.
- The total number of first contacts (Col. A) equals the number of Certificates or Forms received in that month.
- The total of Columns A, B, and C must equal the total of Columns E and F.
- The total of Column G must equal the total of Columns I and J.
- The total of Column H must equal the total of Columns K, L and M.
Example:
Please see sample completed Form. The Rights Adviser received thirty Certificates
or Forms during the month. Twenty were Form 3s, five were Form 4s, two were
financial incapacity (Form 21) and three were treatment incapacity. He/she saw
each person once. He/she saw ten people twice on Form 3s and two people for a
third and subsequent contact. He/she saw one person a second time regarding
treatment incapacity. A person on a Form 4 applied for a hearing but was made
voluntary prior to the hearing. All the visits on the Form 3s took less than
thirty minutes. Of the Form 4 visits, one took an hour and the remainder was
under thirty minutes. Of the visits on the Form 21s, both were under thirty
minutes. Of the treatment incapacity visits, two were over thirty minutes and
two were under.
Please contact Linda Carey at (416) 327-7003 or toll free at 1(800) 578-2343 for assistance in completing the Monthly Rights Advice Data Form.