THE STATE MENTAL HEALTH RULES 1990

G.S.R. 1005 (E), DATED 29TH DECEMBER 1990. 1. - In exercise of the powers conferred by the proviso to sub-section (2) ofSec. 94 of the Mental Health Act 1987 (14 of 1987), read with Sec. 22 of the General Clauses Act, 1897 (10 of 1897 (10 of 1897) the Central Government hereby makes the following rules namely:


Chapter I - Preliminary

1. Short title and commencement
2. Definitions

Chapter II - State Mental Health Authority

1. Constitution of the Authority
   
2. Disqualification
   
3. Chairman
   
4. Term of office of members

Chapter III - Proceedings of the Authority

1. Meetings of the Authority
   
2. Subject for special meeting
   
3. Subjects for the Annual Meeting
   
4. Procedure for holding meetings
   
5. Proceedings of the Authority
   
6. Approval by circulation
   
7. Secretary to the Authority
   
8. Forwarding of copies of the proceedings of the Authority to the State Government

Chapter IV - Licence

1. Application for licence
   
2. Grant of licence
   
3. Refusal of licence and manner of communicating the order
   
4. Application of renewal
   
5. Refusal of licence
   
6. Manner and conditions of maintaining Psychiatric Hospitals or Psychiatric Nursing Homes
   
7. Time for Appeal

Chapter V - Psychiatric Hospital And Nursing Home

1. Minimum facilities for treatment of out-patients
   
2. Revocation of licence
   
3. Maintenance of Records

Chapter VI - Miscellaneous

1. Admission and detention in Psychiatric Hospital or Psychiatric Nursing Home
   
2. The qualifications and functions of the visitors

Forms

1. Form I
   
2. Form II
   
3. Form III
   
4. Form IV
   
5. Form V
   
6. Form VI
   
7. Form VII
   
8. Form VIII
   
9. Form IX

SHORT TITLE AND COMMENCEMENT -

1. These rules may be called the State Mental Health Rules, 1990.
   
2. They shall come into force in a State on the date of commencement of the Act in the State.

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DEFINITIONS - In these rules unless the context otherwise requires -

1. "Act" means the Mental Health Act, 1987 (14 of 1987);
   
2. "applicant" means the person who makes an application to the licensing authority for grant of a licence;
   
3. "authority" means the State Mental Health Authority constituted under Sec. 4 of the Act;
   
4. "Chairman" means the Chairman nominated under rule 5;
   
5. "Form" means Form annexed to these rules;
   
6. "licence" means licence granted under Sec. 8 of the Act;
   
7. "member" means a membber of the Authority appointed under rule 3;
   
8. "membership" means membership of the Authority established under Sec. 4 of the Act;
   
9. "non-official member" means a member appointed under sub-rule (2) of rule 3;
   
10. "official member" means a member appointed under sub-rule (1) of rule 3;
    
11. "secretary" means Secretary to the Authority appointed under rule 13;
    
12. words and expressions used herein and not defined but defined in the Act shall respectively have the meanings assigned to them in the Act.

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"MEANS - EXPRESSION OF. - The expression "means" in a definition clause renders the definition exhaustive of the matter defined. Where an interpretation clause defines a word to mean a particular thing, the definition is explanatory and prima faci restrictive2.

CONSTITUTION OF THE AUTHORITY -

The Authority shall consist of the following members, namely;

1. Official Members:

   1. Secretary, Department of Health;
      
   2. Joint Secretary, Department of Health dealing with Mental Health;
      
   3. Director of Health Services;
      
   4. Medical Superintendent, Government Mental Hospital or Head of the Department of Psychiatry, Government Medical College and Hospital.
   
   

2. Non-official Members:

   Three members including one social worker, one Clinical Psychologist and one Medical Psychiatrist, who in the opinion of the State Government, have special interest in the field of Mental Health.

This rule provides for constitution of the Auathority for purpose of the rules.

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DISQUALIFICATION -

A person shall be disqualified for being appointed as a member or shall be removed from membership by the State Government, if he has been convicted and sentenced to imprisonment for an offence which in the opinion of the State Government involves moral turpitude; or

1. is an undischarged insolvent; or
   
2. is of unsound mind and stands so declared by a competent court; or
   
3. has been removed or dismissed from the service of the Government or a body corporate owned or controlled by the Government.

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CHAIRMAN -

1. The State Government may nominate any official member to act as the Chairman of the Authority.
   
2. The Chairman shall cease to hold office when he ceases to be a member of the Authority.

TERM OF OFFICE OF MEMBERS -

1. Every official member shall hold office as such member so long as he holds the office by virtue of which he was so appointed.
   
2. Every non-official member shall hold office for a period of three years from the date of his appointment and shall be eligible for re-appointment.
   
3. A non-official member may at any time resign from membership of the Authority by forwarding his letter of resignation to the Chairman and such resignation shall take effect only from the date on which it is accepted.
   
4. Where a vacancy occurs by resignation of a non-official member under sub-section (3) or otherwise, the State Government shall fill the vacancy by appointing from amongst category of persons referred to in sub-rule (2) of rule 3 and the person so appointed, shall hold office for the remainder of the term of office of the member in whose place he was so appointed.
   
5. Where the term of office of any non-official membr is about to expire, the State Government may appoint a successor at any time within three months before the expiry of the term of such member but the successor shall not assume duty until the term of the member expires.

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MEETINGS OF THE AUTHORITY -

1. The Authority shall ordinarily meet once in every six months at such time and place as may be fixed by the Chairman: Provided that the Chairman -
   
   1. may call a special meeting at any time to deal with any urgent matter requiring the attention of the Authority.
      
   2. shall call a special meeting if he receives a requisition in writing signed by not less than four members and stating the purposes for which they desire the meeting to be called.
2. The first meeting of the Authority to be held in any calendar year shall be the annual meeting for that year.

PROVISO - It is a cardinal rule of interpretation that a proviso to a particular provision of a statute only embrances the field, which is covered by the main provision. It carves out an exception to the main provision to which it has been enacted by the proviso and to no other. The proper function of a proviso is to except and deal with a case which would otherwise fall within the general language of the main enactment, and its effect is to confine to that case.

Where the language of the main enactment is explicit and unambiguous, the proviso can have no repercussion on the interpretation of the main enactment, so as to exclude from it, by implication what clearly falls within its express terms. The scope of the proviso, therefore, is to carve out an exception to the main enactment and it excludes something which otherwise would have been within the rule. It has to operate in the same field and if the language of the main enactment is clear, the proviso cannot be torn apart from the main enactment nor can it be used to nullify by implication what the enactment clearly says nor set at naught the real object of the main enactment, unless the words of the proviso are such that it is its necessary effect1.

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SUBJECTS FOR SPECIAL MEETING -

Where a meeting referred to in the proviso to sub-rule(1) of rule 7 has been convened, only the subjects for the considerations of which the meeting was convened, shall be discussed.

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SUBJECTS FOR THE ANNUAL MEETING -

At the Annual Meeting of the Authority, the following subbjects shall be considered and disposed of namely;

1. Review of the progress of implementation of the various provisions of the Mental Health Act during the preceding one year;
   
2. Other business brought forward with the consent of the Chairman or where he is absent with the consent of the Officer presiding at the meeting.

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PROCEDURE FOR HOLDING MEETINGS -

1. Every notice calling for meeting of the Authority shall specify the place, date and hour of the meeting;
   
   1. be served upon every member of the Authority not less than twenty-one clear days in the case of annual meeting and fifteen clear days in the case of other meetings before the day appointed for the meeting.
2. The Secretary shall prepare and circulate to the members along with the notice of the meeting, an agenda for the meeting showing the business to be transacted.
   
   
3. A member who wishes to move a resolution on any matter included in the agenda, shall give notice thereof to the Secretary not less than seven days before the date fixed for the meeting.
   
   
4. A member who wishes to move any motion not included in the agenda shall give notice thereof to the Secretary not less than fourteen days before the date fixed for the meeting.

This rule lays down the procedure for holding the meetings.

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PROCEEDINGS OF THE AUTHORITY

1. The Chairman or in his absence any member authorised by him, shall preside at the meetings of the Authority.
   
2. The quorum for the meeting of the Authority shall be four members.
   
3. If within half an hour from the time appointed for holding a meeting of the Authority, quorum is not present, the meeting shall be adjounred to the same day in the following week at the same time and place and the presiding officer of such meeting shall inform the members, present and send notice to other members.
   
4. If at the adjounred meeting also, quorum is not present within half an hour from the time appointed for holding the meeting the members present shall constitute the quorum.
   
5. In the adjounred meeting if the Chairman is not present and no member has been authorised to preside at such meeting, the members present shall elect a member to preside at the meeting.
   
6. Each member including the Chairman shall have one vote. In the case of an equality of votes, the Chairman or any member presiding over such meeting, shall in addition, have a casting vote.
   
7. All decisions of the meeting of the Authority shall be taken by a majority of the members present and voting.

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APPROVAL BY CIRCULATION-

Any business which may be necessary for the Authority to transact except such as may be placed before the annual meeting, may be carried out by circulation among all members and any resolution so circulated and approved by a majority of members shall be valid and binding as if such resolution had been passed at the meeting of the Authority.

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SECRETARY TO THE AUTHORITY -

1. The Chairman shall coause to be appointed a Secretary to the Authority from amongst persons possessing post-graduate degree in Psychiatric and having three years' experience in the field of psychiatry.
   
2. The Secretary shall be a full-time or part-time servant of the Authority and shall function as the Administrative Officer of the Authority.
   
3. The Secretary shall be responsible for the control and management of office accounts and correspondence.
   
4. The Secretary shall attend and take notes of the proceedings of the meeting of the Authority.
   
5. The Secretary shall cause to be appointed such members of the ministerial and non-ministerial staff which are essential for efficient functioning of the Authority.
   
6. The Secretary shall exercise such other powers and discharge such other functions as may be authorised in writing by the Chairman for the efficient functioning of the Authority.

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FORWARDING OF COPIES OF THE PROCEEDINGS OF THE AUTHORITY TO THE STATE GOVERNMENT -

The Secretary shall forward copies of the proceedings of the Authority to the State Government periodically.

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APPLICATION FOR LICENCE -

1. Every application for a licence under sub-section (1) or sub-section (2) of Sec. 7 of the Act shall be -
   
2. made to the licensing authority in Form I or Form II as the case may be;
   
3. accompanied by a fee of rupees two hundred in the form of a bank draft drawn in favour of the licensing authority.

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GRANT OF LICENCE -

If the licensing authority is satisfied that the applicant fulfils the conditions laid down in Cls. (a), (b) and (c) of Sec. 8 of the Act, it shall grant the licence in Form III.

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REFUSAL OF LICENCE AND MANNER OF COMMUNICATING THE ORDER -

1. If the licensing authority is satisfied that the applicant does not fulfill the conditions laid down in Sec. 8 of the Act, it may, after giving the applicant a reasonable opportunity of being heard against the proposed refusal of licence, by order setting out the reasons therein, refuse to grant the licence.
   
2. Every order refusing to grant a licence under Sec. 8 shall be communicated to the applicant by sending a copy of the order by registered post to the address given in the application.
   
3. A copy of the order shall also be conspicuously displayed on the notice-board of the licensing authority.

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APPLICATION OF RENEWAL -

Every application for renewal of a licence under sub-section (5) of Sec. 9 of the Act shall be -

1. Made to the licensing authority in Form IV.
   
2. Accompanied by a fee of rupees one hundred in the form of a bank draft drawn in favour of the licensing authority.

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REFUSAL OF LICENCE -

1. If the licensing authority is satisfied that the conditions mentioned in the proviso to sub-section (5) of Sec. 9 of the Act are not attracted, it shall renew the licence.
   
2. If the licensing authority is of the opinion that the licence should not be renewed in view of the fact the conditions mentioned in the proviso to sub-section (4) of Sec. 9 are attracted, it may, after giving the applicant a reasonable opportunity of being heard against the proposed refusal of renewal of the licence by order setting out the reasons therein, refuse to renew the licence.
   
3. Every order refusing to renew the licence under the proviso to sub-section (5) of Sec. 9 shall be communicated to the applicant by sending a copy of the order by registered post to the address given in the application for renewal.

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MANNER AND CONDITIONS OF MAINTAINING PSYCHIATRIC HOSPITALS OR PSYCHATRIC NURSING HOMES -

Every Psychiatric hospital or nursing home shall be maintained subject to the condition that, -

1. such hospital or nursing home is located only in an area approved by the local authority;
   
2. such hospital or nursing home is located in a building constructed with the approval of the local authority;
   
3. the building, where such hospital or nursing home is sisstuate, has sufficient ventilation and is free from any pollution which may be detrimental to the patients admitted in such hospital or nursing home;
   
4. such hospital or nursing home has enough beds to accommodate the patient;
   
5. the nurses and other staff employed in such hospital or nursing home are duly qualified and competent to handle the work assigned to them;
   
6. the supervising officer-in-charge of such hospital or nursing home is a person duly qualified having a post-graduate qualification in Psychiatry recognised by the Medical Council of India.

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TIME FOR APPEAL -

1. any person aggrieved by the order of the licensing authority refusing to grant or renew a licence or revoking a licence, may prefer an appeal to the State Government within sixty days of the communication of such ordero: Provided that the State Government may entertain an appeal preferred after the expiry of the period specified in sub-rule (1) if it is satisfied that the applicant was prevented by sufficient cause from preferring the appeal in time.
   
2. The appeal shall be in "Form V" and shall be sent to the State Government by registered post or by appearing in person before and delivering the same to the Secretary to State Government, Department of Health or any other officer nominated by him in this behalf.
   
3. Every appeal shall be accompanied with a fee of rupees five hundred.

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MINIMUM FACILITIES FOR TREATMENT OF OUT-PATIENTS -

The minimum facilities required for every psychiatric hospital or psychiatric nursing home for treatment of patients mentioned in Sec. 14 of the Act shall be as follows:

1. Staff for 10 bedded hospital or nursing home -
   
   1. One full time qualified Psychiatrist.
      
   2. One Mental Health Professional Assistant (Clinical) Psychologist or Psychiatrist Social Worker.
      
   3. Staff Nurses in the nurse : patient ratio 1:3
      
   4. Attenders in the attender: patient ratio 1:5
2. Physical features - Adequate floor ospace depending on the number of beds shall be provided.
   
3. Support/facilities - The minimum support/facilities shall be as under:-
   
   1. Provision for emergency care for out-patient and for handling medical emergencies for out-patients and in-patients;
      
   2. A well equipped Electro Convolsive Therapy facility;
      
   3. Psychodiagnostic facilities;
      
   4. Provision for recreational/rehabilitation activities; and
      
   5. Facilities for regular out-patient care.

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REVOCATION OF LICENCE -

1. Where the licensing authority is satisfied that the licence of any psychiatric hospital or nursing home is required to be revoked in pursuance of Cl. (a) or (b) of sub-section (1) of Sec. 11 of the Act, it may, after giving the licensee a reasonable opportunity of being heard against the proposed revocation by order setting out the grounds therein, revoke the licence.
   
2. Every order revoking the licence under sub-rule (1) shall be communicated to the licensee by sending a copy of the order by registered post to the address given in the application.
   
3. A copy of the order shall also be conspicuously displayed on the notice-board of the office of the licensing authority and in the psychiatric hospital or nursing home.

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MAINTENANCE OF RECORDS -

Every Psychiatric hospital or a psychiatric nursing home shall maintain the records of the treatment of patient in Form VI.

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ADMISSION AND DETENTION IN PSYCHIATRIC HOSPITAL OR PSYCHIATRIC NURSING HOME -

1. Application by Medical Officer-in-charge -
   
   1. The application for reception order may be made by the Medical Officer-in-charge of a Psychiatric hospital or Psychiatric nursing home in "Form VII" or
      
   2. by the husband, wife or any other relative of the mentally ill person in "Form VIII".
2. Application from husband or wife:
   
   1. Every application by the husband or wife, relative or friend of a person who is alleged to be mentally ill shall be accompanied by necessary medical certificates;
      
   2. Such application shall be signed either by the husband or wife or relative or friend as the case may be, and verified by two independent witnesses;
      
   3. The name, address, occupation and other details of all the applicants and the attesting witnesses shall be clearly given in such application.

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THE QUALIFICATION AND FUNCTIONS OF THE VISITORS -

1. The qualifications of persons to be appointed as visitors under Sec. 37 of the Act shall be as follows:
   
   1. A degree in Medicine with post-graduate degree in psychiatry awarded by any University in India recognised by the Medical Council of India and having at least ten years' standing in the profession, who has held/is holding the post of Medical Superintendent/Professor in Psychiatric hospital or psychiatric wing of a hospital; or
      
   2. Experience as a social worker/clinical psychologist/psychiatric nurse connected with any mental hospital for a period of not less than ten years.
   
   
2. The visitors appointed by the Government under Sec. 37 of the Act shall be responsible for -
   
   1. review of admission and discharge of patients;
      
   2. inspection of the wards, outdoor patient department and kitchen;
      
   3. facilities to be provided;
      
   4. suggestion for improvement; and
      
   5. functioning as liaison officer between the Government and hospital.

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LEAVE OF ABSENCE -

Every application by relative or any other person on behalf of the patient for leave of absence under Sec. 45 of the Act shall be made in "Form IX".

INTERCEPTION OF THE LETTERS AND OTHER COMMUNICATIONS ADDRESSED TO THE MENTALLY ILL PERSONS -

No letter of other communication addressed to a mentally ill person intended for delivery either through the postal department or otherwise shall be intercepted, detained or destroyed except under following circumstances, namely -

1. any letter or other communication intended for delivery to a mentally ill person shall be opened only if the person having the supervisory control over the hospital or nursing home is of the opinion that such letter or communication contains any information or material which if communicated to such patient will be detrimental to his health; or
   
2. that the interception, detention or destruction of any letter or communication intend to be delivered to the mentally ill person is necessary in the interests of the public or the State.

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To
        The...............Officer,
        Government...............
        ..............................

Dear Sir/Madam,

I/We intend to establish/maintain a Psychiatric Hospital/Psychiatric Nursing Home in respect of which I am/we are holding a valid licence for the establishment/maintenance of such hospital/nursing home. The details of the hospital/nursing home are given below:

1. Name of Applicant
   
2. Details of licence with reference to the name of the Authority issuing the licence and date.
   
3. Age...............
   
4. Professional experience in Psychiatry
   
5. Permanent address of the applicant
   
6. Location of the proposed Hospital/Nursing Home.
   
7. Address of the proposed Nursing Home/Hospital
   
8. Proposed accommodations:
   
   1. Number of rooms
      
   2. Number of beds

Facilities provided:

1. Out-patient
2. Emergency services
   
3. In-patient facilities
   o
4. Occupational and recreational facilities
   
5. ECT facilities
   
6. X-ray facilities
   
7. Psychological testing facilities
   
8. Investigation and laboratory facilities
   
9. Treatment facilities.
   

Staff Pattern:

1. Number of Doctors
   
2. Number of Nurses
   
3. Number of Attenders
   
4. Others

I am sending herewith a bank draft for Rs............ Drawn in favour of............ as licence fee.

I hereby undertake to abide by the rules and regulations of the Mental Health Authority.

I request you to consider my application and grant the licence for establishment/maintenance of Psychiatric Hospital/nursing home.

Yours faithfully,

Signature....................

Name ....................
Date ....................

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APPLICATION FOR ESTABLISHMENT OF PSYCHIATRIC HOSPITAL/NURSING HOME UNDER SUB SECTION (2) OF SEC. 7

To
         The...............
         Government...............
         ...............

Dear Sir/Madam,

I/We intend to establish a Psychiatric Nursing Home/Psychiatric Hospital at ............... (mention the place). I am herewith giving you the details.

1. Name of the Applicant
   
2. Qualification of Medical officer to be incharge of Nursing Home/Hospital (Certificate to be attached).
   
3. Age...............
   
4. Professiona experience in Psychiatry
   
5. Permanent Address of the applicant
   
6. Location of the proposed Hospital/Nursing Home
   
7. Address of the proposed Nursing Home/Hospital
   
8. Proposed accommodation:
   

1. Number rooms,
   
2. Number of beds.

Facilities provided:

1. Out-patient
   
2. Emergency services
   
3. In-patient facilitiesl
   
4. Occupational and recreational facilities
   
5. ECT facilities
   
6. X-ray facilities
   
7. Psychological testing facilities
   
8. Investigation and laboratory facilities
   
9. Treatment facilities
   

Staff Pattern:

1. Number of Doctors
   
2. Number of Nurses
   
3. Number of Attenders
   
4. Others

I am herewith sending a bank draft for Rs...............drawn in favour of............... as licence fee.

I hereby undertake to abide by the rules and regulations of the Mental Health Authority. I request you to consider my application and grant licence.

Yours faithfully,

Signature ....................
Date ....................

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GRANT OF LICENCE FOR ESTABLISHMENT OF PSYCHIATRIC HOSPITAL/NURSING HOME

I..........being the licensing authority under the Mental Health Act, 1987, after considering the application received under Sec. 7 and satisfying the requirements provided for in Sec. 8 and the other provisions of the Mental Health Act, 1987 (Central Act 14 of 1987) and the rules made thereunder, hereby grant the licence for establishment/maintenance of a psychiatric hospital or nursing home in favour of...............( the applicant).

The licence shall be valid for the period commencing from.......... and ending with.......... The licence shall be subject to the conditions laid down in the Mental Health Act, 1987 (14 of 1987) and the rules made thereunder.

                 Licensing Authority
Place..........
Date...........

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APPLICATION FOR RENEWAL OF LICENCE

SEAL
From
       Dr...............
       ...............
       ...............

To
       District Health Officer
       ...............
       ...............

Sir,

Subject : Renewal of Licence No...............dated.......... I request you to kindly renew my licence No.......... dated the..........for the next 5 years. I am providing the facilities as prescribed by the Act and the rules framed thereunder. I have herewith attached a demand draft for Rs. 100 only.

Thanking you.

Yours faithfully

Signature...............

Name ...............

Place...............
Date...............

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APPLICATION FOR APPEAL

To,
         The Appellate Authority
         Government...............
         ...............

Sir,

I, Dr...............of...............had applied for licence for establishing a Pspychiatric Nursing Home/Hospital at...............(copy of the earlier application to be attached). My application was rejected by the licensing authority as per his/her letter No.--------------

1. 
   
2. 
   
3. 
   (copy enclosed)
   The above reason(s) appear to be not valid. I request you to reconsider my application. My justifications are:
4. 
   
5. 
   

I am willing to appear before you for a personal hearing, if necessary. I am herewith enclosing a draft for Rs. 500.

Thanking you.

Yours faithfully,

Signature...............

Name...............

Place...............
Date...............

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PROFORMA OF CASE RECORD

Name of the hospital/nursing home............... Patient's name............... Age.............. Sex............... Date of admission.............. date of discharge........ Mode of admission.............. Voluntary.

Reception order.

Complaints (report from relative/other sources)
Mental State Examination
Physical Examination
Laboratory investigations
Provisional diagnosis.
Initial treatment
Treatment and Progress notes

Clinical State and side effect Treatment

Date

Final diagnosis
Condition at discharge
Follow-up recommendations.

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APPLICATION FOR RECEPTION ORDER
(By Medical Officer-in charge of a Psychiatric Hospital)

From

       Dr.........

To

      *The Magistrate
       ..............
       ..............

Sir,

Subj: Reception order for.............. son/daughter of......... I, Dr.............. maintain psychiatric hospital/nursing home at.............. Under licence No......... dated.........

I request you to issue reception order in respect of Sh/Smt... ... ... son/daughter Of ........ who is being treated at my hospital as a voluntary patient and is not willing to continue. He/she has the following symptoms and/or signs.

1. 
   
2. 
   
3. 
   
4. 
   

He/She requires to be in the hospital for treatment/personal safety/others Protection.

Thanking you.

Yours Sincerely,

Signature ..............

Name ..............

Place ..............
Date .............

"Magistrate" means -

1. In relation to a metropolitan area within the meaning of Cl.(k) of Sec. 2 of the Code of Criminal Procedure. 1973, a Metropolitan Magistrate.
   
2. In relation to any other area, the Chief Judicial Magistrate, Sub-Divisional Judicial Magistrate or such other Judicial Magistrate of the first class as the State Government may, by notification, empower to perform the functions of a Magistrate under this Act.

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APPLICATION FOR RECEPTION ORDER
(By relative or other)

To
       ..............
       ..............
       ..............

Sir,

Subject: Admission of ............son/daugher of .........into psychiatry hospital/nursing home as in-patient.

I .........son/daughter of .........residing at .........request you kindly arrange for admission in respect of Sh/Smt ................... Aged ......... Years ..........son/daugher of ............ An in-patient To .........(name of the hospital) or any other hospital/nursing home. He/She has the following suggestive of mental illness.

1. 
   
2. 
   
3. 
   
4. 
   

I, who is ............(relationship) of Sh./Smt .............. have an income .........Rs ...... and agree to pay the charges of treatment, if any of the institution. I state that, I have/bave not made any such regard to the mental condition of .........as required. I herewith enclose the two medical certificates needed for the purpose.

Witnesses:

Yours faithfully,

Name .........

Signature ..........

Address ..........

Name in Capital .....................Occupation ..............

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APPLICATION FOR LEAVE OF ABSENCE
(By relative or others)

To

       Dr. .............................
       ............

Sir,

Subject: Request for leave of absence of Sh/Smt .........aged .........years Admitted on ..............to your Institute.

I request that Sh/Smt ........son/daughter of ......... Be delivered to my care and custody on leave of absence.

I hereby bind myself that on the said Sh/Smt .............. being made over to my care and custody, I will have him here/properly taken care of and prevent from doing injury to himself or to others.

Yours faithfully,

Signature ..............

Name ..............

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