FORMS


§ 5100.41. Forms.

 (a)  Reference. All references to article or section numbers in the title of the forms issued by the Department refer to articles or section numbers of the act.

 (b)  Forms. Forms adopted by the Department as published in prior regulations may be amended to conform with the act by pen and ink changes until new forms are available:

   MH 781. Consent for Voluntary Inpatient Treatment (Article II).

     MH 781-A. Initial Evaluation.

     MH 781-B. Explanation of Voluntary Admission Rights (Adult).

     MH 781-C. Explanation of Voluntary Admission Rights (Minor between 14 and 18 years of age).

     MH 781-D. Explanation of Voluntary Admission Rights (Minor under 14 years of age.

     MH 781-E. Notification of Admission of Child (For parents or guardians of minor 14-18 years old).

     MH 781-F. Request to Withdraw from Treatment.

     MH 781-X. Request for Voluntary Admission of Person Charged with Crime or Serving Sentence.

     MH 781-Y. Consent for Voluntary In-patient Treatment of Person Charged With Crime or Serving Sentence.

     MH 781-Z. Explanation of Admission of Person Charged With Crime or Serving Sentence.

   MH 782. Patient’s Bill of Rights.

   MH 783. Application for Involuntary Emergency Examination and Treatment.

     MH 783-A. Explanation of Rights under Emergency Involuntary Treatment.

     MH 783-B. Explanation of Warrant.

   MH 784. Application for Extended Involuntary Treatment (section 303).

     MH 784-A. Notice of Intent to File or Petition for Extended Involuntary Treatment and Explanation of Rights.

   MH 785. Petition for Involuntary Treatment.

     MH 785-A. Notice of Intent to File a Petition for Extended Involuntary Treatment and Explanation of Rights.

     MH 785-B. Notice of a Hearing on Petition for Involuntary Treatment and Explanation of Rights.

   MH 786. Petition for Involuntary Treatment—Through the Criminal Justice System.

     MH 786-A. Notice of Intent to File a Petition for (Extended) Involuntary Treatment at a Mental Health Facility and Explanation of Rights.

   MH 787. Petition for Commitment for Involuntary Treatment After Finding of Incompetence to Stand Trial Where Severe Mental Disability is Not Present.

   MH/MR 50. Patient Consent to Transfer.

 (c)  Forms amended in this chapter include:

   MH-781-X

   MH-788

Cross References

   This section cited in 55 Pa. Code §  5100.23 (relating to written application, petitions, statements and certifications).



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