Proceeding No:
/
MENTAL HEALTH COURT
Reference of person’s mental condition to the
Mental Health Court by Registrar of the Supreme
or District Court
Mental Health Act 2000 Queensland
Section 63 & 264
Approved form No: MHC.01



If at the trial of the person charged with an indictable offence, the person pleaded guilty and it is alleged
or appears the person is mentally ill, or was, or may have been, mentally ill when the alleged offence
was committed; or
On the appearance for sentence of the person who has pleaded guilty to a charge of an indictable
offence before a court and has been committed by the court for sentence, it is alleged or appears the
person is mentally ill, or was, or may have been, mentally ill when the alleged offence was committed;
The Supreme or District Court before which the person appears may order a plea of not guilty be
entered, adjourn the trial, refer the matter of a person's mental condition relating to the offence to the
Mental Health Court and remand the person in custody or grant the person bail under the Bail Act 1980.
BLOCK LETTERS
Personal details
The person being
referred
Given name/s
Family name
Also known as
Residential address
Town/suburb
State QLD
Postcode
Phone No.
or
Date of birth
Mark  applicable box
Male
Age
Female
Details of charge/s
Date of
offence
Charge
Provide details of the
offence/s
including summary
matters
Mark  applicable box
Court
Court file no. /
indictment no.
**additional schedule of offences is attached
The person has:
Mark  applicable
box(es)

been remanded in custody
Name of facility

had a court assessment order made
Name of authorised mental health service
OR

been granted bail under the Bail Act 1980
Notice
The matter of the person’s mental condition relating to the offence is referred to the Mental Health Court.
Attach document
Attached is a copy of the medical report produced in the court relating to the person’s mental condition.
Registrar of Supreme
or District Court
Signature
seal
Print name
Date
To:
/
/
Registrar, Mental Health Court
GPO Box 48, BRISBANE QLD 4001
continued over page…
version 2
June 2002
Proceeding No:
/
To be completed by Registrar, Mental Health Court
Notice
Registrar Mental
Health Court
seal
Signature
Print name
Date
Copy to:
mhc.063
/
/
the person
legal representative
Attorney-General
Director of Mental Health
Director of Public Prosecutions
if applicable - administrator, authorised mental health service
version 1
February 2002