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.


Amendment to guidance and application form for Section 17 Leave of Absence

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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:

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

Published 27 February 2011
Last updated 2 August 2019 + show all updates
  1. updated email address for completed submissions
  2. Updated leave application and medical leave application forms.
  3. Updated instructions for sending completed forms
  4. Leave application form for restricted patients updated
  5. Addition: Medical leave application form for restricted patients
  6. Updated form and guidance
  7. First published.