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Lauren Anne Dickason was scheduled to appear in the High Court at Timaru just after 9am.
However, as she is "still unwell" she was not in court in person or via audio visual link.
The 40-year-old doctor is facing three charges of murder after allegedly killing her daughters Liané, 6 and 2-year-old twins Maya and Karla on September 16.
The hearing was held in Christchurch before Justice Cameron Mander.
Dickason remains in the Hillmorton Hospital's secure forensic mental health unit.
She was remanded there - rather than prison - at her first appearance in Timaru on September 18.
Her earlier appearance in the High Court on October 5 was excused until today as a mental health assessment was ongoing.
Defence lawyer Kerryn Beaton QC told the court today Dickason would be entering pleas of not guilty to all three charges.
Because she was not in court, Dickason will sign a document confirming that and the pleas would be formally entered later today.
Beaton, with support from Dickason's treating psychiatrist, sought a further remand to Hillmorton until her next appearance.
The court heard that Dickason needed ongoing assessment as an inpatient.
Crown Prosecutor Andrew McRae, from Timaru, did not oppose that.
Justice Mander said further psychiatric reports were being prepared and granted that remand.
The specific information contained in those reports are suppressed.
Dickason's next court date is December 17 where here case will be reviewed.
A trial date has been set for March 2023 in Timaru.
The specific details of the alleged murders have been suppressed.
The Dickason family arrived in Timaru just a week before the children died after spending their mandatory stint in managed isolation.
They moved here from Pretoria in South Africa and spent their mandatory time in managed isolation before they were released to start their new life.
Graham Dickason is an orthopaedic surgeon and had a job with the South Canterbury District Health Board.
It is understood he had been at a work function with colleagues and arrived home to find the grisly scene.
He has not attended any of his wife's court appearances to date.
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633 ,free text 234 or email email@example.com or online chat.
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757
• SAMARITANS – 0800 726 666.