Forms
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. | ||||