Schedule 1Medical certificate as to examination of inmate

# Schedule 1 Medical certificate as to examination of inmate Schedule 1 Medical certificate as to examination of inmate (Section 86(3)) **[Mental Health and Cognitive Impairment Forensic Provisions Act 2020](/view/html/inforce/current/act-2020-012)** I, \[*name in full—use block letters*\] (\*Medical Practitioner/Psychiatrist) of do certify that on \[*date*\] at \[*state place where examination took place*\], separately from any other medical practitioner, I personally examined \[*name of inmate in full*\] \*detained at \[*name of correctional centre or detention centre where inmate is imprisoned or detained if not the place where the examination took place*\], and I am of the opinion that \*he/she is \*a mentally ill person/a person who has a condition for which treatment is available in a mental health facility. I have formed this opinion on the following grounds— > (1) Facts indicating \*mental illness/condition observed by myself. > ............................................................ > ............................................................ > ............................................................ > ............................................................ > (2) Other relevant information (if any) communicated to me by others (state name and address of each informant). > ............................................................ > ............................................................ > ............................................................ > ............................................................ > ............................................................ Made and signed this \[*date*\] \[*Signature*\] \*Delete whichever does not apply. **sch 1:** Am 2022 No 6, Sch 1.4.