MRCPsych Documentation and Record Keeping 2 — Questions and Answers
Question 1: Under the Mental Health Act 1983, which document must be completed when a patient detained under Section 2 is to be transferred to another hospital?
- Form H3 (Correct answer)
- Form H4
- Form H5
- Form H1
Correct answer: Form H3
Form H3 is the statutory document required to authorize the transfer of a detained patient under Section 19 of the MHA 1983.
Question 2: Which standard best describes the minimum frequency for updating a risk assessment in a community mental health setting for a high-risk patient?
- Annually
- At every significant change in clinical status (Correct answer)
- Monthly regardless of clinical change
- Only at Care Programme Approach (CPA) reviews
Correct answer: At every significant change in clinical status
Risk assessments must be reviewed and updated at every significant change in clinical status rather than at fixed intervals alone.
Question 3: A psychiatrist writes a court report for a patient charged with assault. Which principle governs the duty of disclosure of that report to the patient?
- The report is automatically privileged and need not be disclosed
- The commissioning solicitor controls disclosure, not the clinician (Correct answer)
- The patient has an absolute right to see all court reports about them
- The Data Protection Act 2018 requires immediate disclosure on request
Correct answer: The commissioning solicitor controls disclosure, not the clinician
Court reports prepared for legal proceedings are covered by legal professional privilege and disclosure is controlled by the instructing solicitor, not the clinician.
Question 4: When documenting capacity assessments in the UK, which element is NOT a required component of the Mental Capacity Act 2005 four-stage test?
- Understand the relevant information
- Retain the information
- Predict future consequences of a decision (Correct answer)
- Use or weigh the information
Correct answer: Predict future consequences of a decision
The MCA 2005 four-stage test covers understanding, retaining, using/weighing, and communicating — predicting future consequences is not a discrete stage.
Question 5: In an inpatient psychiatric unit, a nurse asks a junior doctor to countersign a PRN medication administration that the nurse gave 6 hours ago. What is the correct documentation approach?
- Refuse to countersign any retrospective entry
- Countersign only if the drug was appropriate and document the time of countersigning separately (Correct answer)
- Sign as if present at the time of administration
- Ask the pharmacist to validate the entry instead
Correct answer: Countersign only if the drug was appropriate and document the time of countersigning separately
Retrospective countersigning is permissible if the clinician is satisfied the administration was appropriate, but the time of review must be documented clearly.
Question 6: Which of the following best describes the purpose of the 'problem list' in a psychiatric case note system?
- A static list of diagnoses recorded at first assessment only
- A dynamic, cumulative record of all active and historical clinical problems (Correct answer)
- A billing summary required by insurance providers
- A list of medications that have caused adverse reactions
Correct answer: A dynamic, cumulative record of all active and historical clinical problems
The problem list is a dynamic record that reflects active and resolved problems, supporting longitudinal care and continuity across providers.
Question 7: A patient's next-of-kin requests copies of the deceased patient's psychiatric records. Under UK law, which legislation primarily governs this request?
- Freedom of Information Act 2000
- Access to Health Records Act 1990 (Correct answer)
- Data Protection Act 2018
- Mental Health Act 1983
Correct answer: Access to Health Records Act 1990
The Access to Health Records Act 1990 specifically governs requests for the health records of deceased persons by their personal representatives or those with a claim arising from the death.
MRCPsych Documentation and Record Keeping 2
Under the Mental Health Act 1983, which document must be completed when a patient detained under Section 2 is to be transferred to another hospital?