Form

Request leave for restricted patients

Complete this form to apply for S17 leave for a restricted patient being treated for mental health issues at your hospital.

From:
HM Prison and Probation Service
Published
27 February 2011
Last updated
11 May 2021 — See all updates

Applies to England and Wales

Documents

Leave application form for restricted patients

MS Word Document, 79.4 KB

Medical leave application form for restricted patients

MS Word Document, 143 KB

MHCS Leave Guidance for Medical Professionals

MS Word Document, 215 KB

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MHCS Leave Guidance for Medical Professionals (Welsh)

MS Word Document, 212 KB

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Medical Leave Guidance

MS Word Document, 211 KB

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Medical Leave Guidance - (Welsh)

MS Word Document, 267 KB

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Details

Important Information for Responsible Clinician’s applying for patients to have overnight leave for the Christmas period:

The cut-off date for these applications is 18th November 2022. Please ensure that your applications are submitted by this date in order to allow sufficient time for a risk assessment to be undertaken and a decision made. If any applications are received after this date, we cannot guarantee that a decision will be made prior to Christmas.

This form should be filled in by the clinician responsible for the restricted patient’s care.

Complete the relevant form depending on which type of S17 leave of absence you are requesting for the patient. You can also use it to report changes in the patient’s circumstances.

The Secretary of State must have an up-to-date report on all previous leave before considering any new requests.

Check the attached guidance if you need more information.

Email the completed document to: MHCSMailbox@justice.gov.uk

After the patient has returned, you must fill in a completed leave report.

Published 27 February 2011
Last updated 11 May 2021 + show all updates

  1. Leave Application Form for restricted patients updated.

  2. Guidance for medical professionals dealing with leave for restricted patients moved to another collection.

  3. Welsh version of Guidance uploaded.

  4. Updated 'Guidance for medical professionals dealing with leave for restricted patients'

  5. Updated leave application form attachment

  6. updated email address for completed submissions

  7. Updated leave application and medical leave application forms.

  8. Updated instructions for sending completed forms

  9. Leave application form for restricted patients updated

  10. Addition: Medical leave application form for restricted patients

  11. Updated form and guidance

  12. First published.

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