{"id":12113,"date":"2016-03-29T13:37:26","date_gmt":"2016-03-29T17:37:26","guid":{"rendered":"http:\/\/www.nbrhc.on.ca\/fr\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\/mental-health-forms\/"},"modified":"2026-04-08T15:40:12","modified_gmt":"2026-04-08T19:40:12","slug":"formulaire-sante-mentale","status":"publish","type":"page","link":"https:\/\/nbrhc.on.ca\/fr\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\/formulaire-sante-mentale\/","title":{"rendered":"Formulaires de sant\u00e9 mentale et de toxicomanies"},"content":{"rendered":"<h2>Formulaires de demande<\/h2>\n<table id=\"jobtable\" style=\"width: 100%;\" border=\"2\" summary=\"Formulaire de demande de sant\u00e9 mentale et de toxicomanies\" cellspacing=\"4\" cellpadding=\"4\">\n<colgroup>\n<col style=\"width: 70%;\" \/>\n<col style=\"width: 12%;\" \/>\n<col style=\"width: 18%;\" \/> <\/colgroup>\n<thead>\n<tr>\n<th class=\"header headerSortDown\" scope=\"col\" valign=\"top\">\n<h3><strong>Nom<\/strong><\/h3>\n<\/th>\n<th class=\"header\" scope=\"col\" valign=\"top\">\n<h3><strong>Num\u00e9ro<\/strong><\/h3>\n<\/th>\n<th class=\"header\" scope=\"col\" valign=\"top\">\n<h3><strong>Langue<\/strong><\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2016\/03\/2209.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Outpatient Psychiatry Clinic Consultation<\/a><\/td>\n<td style=\"text-align: center;\">RHC\u00a02209<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2>Formulaires de r\u00e9f\u00e9rence<\/h2>\n<table id=\"jobtable\" style=\"width: 100%;\" border=\"2\" summary=\"Formulaires de r\u00e9f\u00e9rence de sant\u00e9 mentale et de toxicomanies\" cellspacing=\"4\" cellpadding=\"4\">\n<colgroup>\n<col style=\"width: 70%;\" \/>\n<col style=\"width: 12%;\" \/>\n<col style=\"width: 18%;\" \/> <\/colgroup>\n<thead>\n<tr>\n<th class=\"header headerSortDown\" scope=\"col\" valign=\"top\">\n<h3><strong>Nom<\/strong><\/h3>\n<\/th>\n<th class=\"header\" scope=\"col\" valign=\"top\">\n<h3><strong>Num\u00e9ro<\/strong><\/h3>\n<\/th>\n<th class=\"header\" scope=\"col\" valign=\"top\">\n<h3><strong>Langue<\/strong><\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2016\/03\/817-June-2013.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Regional Mental Health Central Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC\u00a0817<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/nbrhc.on.ca\/wp-content\/uploads\/2025\/01\/RHC-1646-Central-Intake-Referral-Form_Fillable.pdf\" target=\"_blank\" rel=\"noopener\">Central Intake Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC\u00a01646<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2016\/08\/RHC1938-dds-nip-physician-referral-form.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Developmental Disabilities Service Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC 1938<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/nbrhc.on.ca\/wp-content\/uploads\/2023\/10\/RHC-2697-Outpatient-Specialized-Geriatric-Services-Referral-Form-October-12-2023.docx\" target=\"_blank\" rel=\"noopener\">Outpatient Specialized Geriatric Services Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC 2697<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2020\/11\/ReferralHB_FR_RHC3049_Final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Forensic Inpatient Service for Adult Women (Hummingbird Lodge) Referral Information<\/a><\/td>\n<td style=\"text-align: center;\">RHC 3049<\/td>\n<td style=\"text-align: center;\">fran\u00e7ais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2022\/01\/2021-New-ACTT-Referral-Final_.pdf\" target=\"_blank\" rel=\"noopener\">ACTT Referral<\/a><\/td>\n<td style=\"text-align: center;\">RHC 3154<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/nbrhc.on.ca\/wp-content\/uploads\/2026\/02\/RHC-3486-Child-and-Adolescent-Psychiatry-Referral-Form.pdf\" target=\"_blank\" rel=\"noopener\">Child and Adolescent Psychiatry Outpatient Consultation Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC 3337<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2016\/03\/2129-April-2014.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Pediatric Acute Mental Health Admission Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC\u00a02129<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/nbrhc.on.ca\/wp-content\/uploads\/2025\/05\/RHC-3428-Eating-Disorder-Referral.pdf\" target=\"_blank\" rel=\"noopener\">Eating Disorder Program Referral Form<\/a><\/td>\n<td style=\"text-align: center;\">RHC 3428<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/nbrhc.on.ca\/wp-content\/uploads\/2026\/01\/RHC-3627-Temiskaming-BSO-SMH-Referral-Form-18-07-2025.pdf\" target=\"_blank\" rel=\"noopener\">Temiskaming Seniors\u2019 Mental Health and Behavioural Supports Ontario Referral Form<\/a><\/td>\n<td style=\"text-align: center;\"><span>RHC 3627\u00a0<\/span><\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2>Judges Handbook<\/h2>\n<table id=\"jobtable\" style=\"width: 100%;\" border=\"2\" summary=\"Judges Handbook\" cellspacing=\"4\" cellpadding=\"4\">\n<colgroup>\n<col style=\"width: 70%;\" \/>\n<col style=\"width: 12%;\" \/>\n<col style=\"width: 18%;\" \/> <\/colgroup>\n<thead>\n<tr>\n<th class=\"header headerSortDown\" scope=\"col\" valign=\"top\">\n<h3><strong>Nom<\/strong><\/h3>\n<\/th>\n<th class=\"header\" scope=\"col\" valign=\"top\">\n<h3><strong>Num\u00e9ro<\/strong><\/h3>\n<\/th>\n<th class=\"header\" scope=\"col\" valign=\"top\">\n<h3><strong>Langue<\/strong><\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><a href=\"\/wp-content\/uploads\/2017\/12\/Final-to-print-Judges_Handbook_2017_Sept-3.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Judges Handbook<\/a><br \/>\nA Summary of Important Features in Part XX.I of the Criminal Code and Considerations about Fitness to Stand Trial and Criminal Responsibility for Court Justice Officials in the Northeast Region.<br \/>\n<em>Third Edition, Revised September 2017<\/em><\/td>\n<td style=\"text-align: center;\">No RHC #<\/td>\n<td style=\"text-align: center;\">anglais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"<p>Formulaires d&rsquo;orientation et d&rsquo;admission pour les services de sant\u00e9 mentale et de toxicomanies (Programme r\u00e9gional d&rsquo;interventiopn en sant\u00e9 mentale et programme de sant\u00e9 mental pour personnes \u00e2g\u00e9es et Programme r\u00e9gional sp\u00e9cialis\u00e9 de sant\u00e9 mentale).<\/p>\n","protected":false},"author":17,"featured_media":0,"parent":5962,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_links_to":"","_links_to_target":"","_wp_rev_ctl_limit":""},"tags":[1607,1609,2422,1585,1581,2423,2588,2674,1613,1608,1610,2248,2424,1586,1582,2426,2673,1614],"class_list":["post-12113","page","type-page","status-publish","hentry","tag-rhc-1646-fr","tag-rhc-1659-fr","tag-rhc-1938-fr","tag-rhc-2129-fr","tag-rhc-2209-fr","tag-rhc-2697-fr","tag-rhc-3049","tag-rhc-3154-fr","tag-rhc-817-fr","tag-rhc1646-fr","tag-rhc1659-fr","tag-rhc1696","tag-rhc1938-fr","tag-rhc2129-fr","tag-rhc2209-fr","tag-rhc2697-fr","tag-rhc3154-fr","tag-rhc817-fr"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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