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These forms are grouped here (in PDF format) for easier accessibility. You can download the pdf reader for free from this site http://www.adobe.com/products/acrobat/readstep2.html
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Medical Doctors Forms
These forms are for use by medical practitioners in Malta only. Unauthorised use can lead to prosecution under the relevant ordinance or legislation.
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| 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 |
ONLINE Ticket of referral to Mater Dei Hospital |
| Reason for use |
Medical Doctors can refer patients to an outpatients appointment |
| Remarks |
Medical Doctors need to logon with their E-ID to access this service. |
| Form |
Revised Death Certificate |
| Reason for use |
To notify a death. |
| Remarks |
PDF version of death certificate may be completed online, printed, signed and sent in the usual manner.
Word version of death certificate available on request.
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| Further information |
National Mortality Registry, Dept. of Health Information & Research |
| 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 |
| Form |
Schengen Medical Certificate |
| Reason for use |
To fill in for residents in Malta who want to travel to another Schengen State and who, owing to medical treatment, need to take a narcotic drug and /or psychotropic substance during this period. |
| Remarks |
Certificate is valid only for a maximum of 30 days.
Medical practitioners are to fill in sections A, B and C only whilst subsequently Section D is to be authenticated by the Drug Control Unit at 3B Old Mint Street, Valletta.
Print both sides of certificate.
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| 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 |
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 |
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| 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.
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| 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 |
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| Form |
- REQUEST FOR THE INTRODUCTION OF
NEW HEALTH TECHNOLOGY/SERVICE
- Guide for Completion of the Request Form
for the Introduction of New Health
Technologies and Services |
| Reason for use |
Requesting the introduction of new health technology or service. |
| Further information |
Strategy and Sustainability Division |
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Public Health Forms
These are some of the forms which the Public Health Department uses and are now available to the general public.
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| Form |
Application for Pharmacist |
| Reason for use |
Qualified Person (Pharmacist) For Wholesale Dealing Activity Declaration |
| Form |
Application Form for Food Handlers Document |
| Also |
Notes on Food Handlers Document's application |
| Reason for use |
To apply for the document which anyone working in a place where food is prepared, should have |
| Further Information |
Food Safety Unit , Public Health Dept. |
| Forms |
Application for Registration of Food Premises (food business) English / Malti
Notes to assist in the filling of the Application Form for Registration of Food Premises English / Malti |
| Reason for use |
Application to open a premises where food is prepared. |
| Further information |
Food Safety Unit , Public Health Dept. |
| Form |
Application for Registration of Food Premises (primary production) English / Malti |
| Reason for use |
Application to open a premises where food is prepared. |
| Further information |
Food Safety Unit , Public Health Dept. |
| Form |
Application For a Licence |
| Reason for use |
Application For a Licence from the Superintendent of Public Health |
| Form |
Request For The Attendance Of Port Health Officials |
| Reason for use |
For the issue of Deratting Exemption Certificate or Deratting Certificate |
| Further information |
Port Health, Public Health Dept. |
| Form |
Applikazzjoni ghal sit ta' qabar |
| Reason for use |
Application to buy a gravesite |
| Further information |
Burials Administration Unit, Public Health Dept. |
| Form |
Application for the approval of a Marble/Stone monument at Sta.Maria Addolorata Cemetry |
| Reason for use |
To erect a monument on a gravesite |
| Further information |
Burials Administration Unit, Public Health Dept. |
| 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. |
| Form |
Application form in english |
| Notes |
Application Form For The Filling of Posts/Positions in the Public Service |
| Form |
Applikazzjoni bil-Malti |
| Notes |
Applikazzjoni Ghall-Mili Ta' Postijiet/Pozizzjonijiet fis-Servizz Pubbliku |
| Form |
Request for data from the Department of Health Information |
| Notes |
Please read the "Policy for Patient-Identifiable Data" before sending your requests. |
| Form |
Application
for Smoking Cessation Clinic |
| Notes |
Application will be sent to Department of Health Promotion |
| Form |
Genitourinary Clinic (GU) - Boffa Hospital |
| Notes |
Request for information or advice on sexually transmitted disease and/or elated issues. All information given will be kept
strictly confidential. Requests received by Dr Philip Carabot (Doctor-in-charge GU Clinic) |
| Form |
Contact us/Feedback Form |
| Notes |
Application will be sent to info.moh@gov.mt |
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More forms will be added in the future.
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