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Other forms:

These forms are for use by medical practitioners in Malta  only. Unauthorised use can lead to prosecution under the relevant ordinance or legislation.
 

Form Ticket of referral to the A & E Department (Dh 137/2011)
Reason for use To refer patients to the Accident and Emergency Department of a Government Hospital
Remarks Please print both pages.
   
Form Ticket of referral to a Government hospital
Reason for use To refer patients to either to Casualty, or for an outpatients and/or health centre appointment
Remarks Please print both sides of the ticket.
Form DH/MHA 1- Application for admission to Mount Carmel Hospital
Reason for use Application for Admission for Observation (Section 14 and 16)
Remarks This application is valid only for 14 days beginning with the date appearing on the medical recommendation last given as the date on which the patient was last examined by the medical practitioner before giving that recommendation.
Form DH/MHA 2- Application for admission to Mount Carmel Hospital
Reason for use Emergency Application for Admission for Observation (Section 15 and 16)
Remarks This application is valid only for 2 days beginning with the date appearing on the medical recommendation as the date on which the patient was last examined by the medical practitioner before giving that recommendation.
Form DH/MHA 3- Application for admission to Mount Carmel Hospital
Reason for use Medical Recommendation for Admission for Observation (Section 14, 15 and 17)
Remarks See Explanatory Note on form
Form DH/MHA 4- Application for admission to Mount Carmel Hospital
Reason for use Joint Medical Recommendation for Admission for Observation (Section 14)
Remarks See Explanatory Note on form
Form DH/MHA 5- Application for admission to Mount Carmel Hospital
Reason for use Application by Nearest Relative for Admission for Treatment (Section 14 and 16)
Remarks This application is valid only for 14 days beginning with the date appearing on the medical recommendation as the date on which the patient was last examined by the medical practitioner before giving that recommendation.
Form DH/MHA 6- Application for admission to Mount Carmel Hospital
Reason for use Application by a Mental Welfare Officer for Admission for Treatment (Section 14 and 16)
Remarks This application is valid only for 14 days beginning with the date appearing on the medical recommendation as the date on which the patient was last examined by the medical practitioner before giving that recommendation.
Form DH/MHA 7- Application for admission to Mount Carmel Hospital
Reason for use Medical Recommendation for Admission for Treatment (Section 14)
Remarks refer to Explanatory Note on form
Form DH/MHA 8- Application for admission to Mount Carmel Hospital
Reason for use Joint Medical Recommendation for Admission for Treatment (Section 14)
Remarks See Explanatory Note on Form
Form DH/MHA 13
Reason for use Application to Mental Health Review Tribunal by Patient in Hospital
Remarks none
   
Form Notification of Cancer form
Reason for use To notify a new case of cancer
Further information National Cancer Registry,Dept. of Health Information
Form Death Certificate
Reason for use To notify a death.
Remarks Fill details directly on the pdf form and print it.
Further information National Mortality Registry, Dept. of Health Information
Form Notification of Infectious Diseases
Reason for use To notify new cases of any infectious disease
Remarks Updated version of the form. (Revised May 2004)
Further information Department of Public Health
Form Request For The Issue/Renewal of a Control Card For Narcotic And Psychotropic Drugs
Reason for use To apply for the white dangerous drugs card or renew expired ones.
Further information Drug Control Unit - Public Health Dept

Public Health Forms

These are some of the forms which the Public Health Department uses and are now available to the general public.

Form Application for Pharmacist
Reason for use Qualified Person (Pharmacist) For Wholesale Dealing Activity Declaration
Form Application For Grant / Renewal/ Transfer Of Licence In Terms Of The Dispensaries (Licensing) Reulations, 1984
Reason for use Application for opening/renewing or transfer of a pharmacy. To be returned to the Medical Officer of Health
Further information     Drug Control Unit, Public Health Dept.











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The information provided is intended to serve as a bona fide aid to Maltese Medical Practitioners. I, the website administrator, rely on third party information and therefore cannot accept liability for any errors or omissions. Should any inaccuracies in the data provided be noted, please contact me immediately so that I will make the necessary corrections promptly.