WebAPPLICATION FOR INVOLUNTARY ADMISSION This application for involuntary admission to a facility for the care or treatment of a mental disorder may be signed by any person who has a legitimate interest in the welfare of the individual (Health-General Article, §10-614, Annotated Code of Maryland). This application must be accompanied by … WebFORM MHCA 04 DEPARTMENT OF HEALTH APPLICATION TO THE HEAD OF HEALTH ESTABLISHMENT CONCERNED FOR ASSISTED OR INVOLUNTARY CARE, TREATMENT AND REHABILITATION [Section 27(1) and 27(2) or 33(1) and 33(2) of the Act] (A staff member assisting the Applicant in completing this form must record his/her …
persons who appear to be mentally ill and who display an …
WebPETITION AND CERTIFICATE FOR INVOLUNTARY EMERGENCY ADMISSION (IEA) 3. Physical examination of: Name of person (petitionee) sought to be admitted Print … WebFeb 18, 2024 · hospital approved by the Commissioner for the purpose of evaluation for admission if such person appears to be mentally ill and is conducting himself or herself … flea market apache junction arizona
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WebOnce the Form 3 expires, your involuntary admission may be renewed using a Form 4 – Certificate of Renewal. If there's a certificate with your name that hasn't expired and your doctor hasn't changed your status to a voluntary patient, then you can't leave the facility without your doctor's permission. If you leave the facility without ... Web3. TIME 4. PRISONER NAME (Last, First, Middle) 5. REGISTRATION NUMBER 6. SEGREGATION AUTHORIZED BY. a. PRINTED NAME (Last, First) b. SIGNATURE c. … cheesecake nutrition information