§ 5100.72. Applications.

 (a)  Written application for voluntary inpatient treatment shall be made upon Form MH-781, issued by the Department.

 (b)  A State-operated facility shall not accept an application for voluntary inpatient treatment for persons not currently in the facility unless:

   (1)  There is concurrence on an individual case basis given by the administrator.

   (2)  There is a preexisting agreement of waiver approved by the Deputy Secretary of Mental Health between the State facility and the Administrator which designates that facility as the only provider of inpatient services of the county program.

   (3)  There is a preexisting letter of agreement approved by the Deputy Secretary of Mental Health between the State facility and the Administrator which designates the State facility as:

     (i)   A substitute provider of inpatient services on a temporary basis when an emergency need arises and there are no other appropriate approved facilities available; or

     (ii)   A provider of specialized forensic inpatient services when a need for security arises.

   (4)  Such letter of agreement shall define the nature of security to be available and the responsibilities of both the State facility and the administrator.

 (c)  When application is made to an approved facility, the director of the facility shall:

   (1)  Be responsible for insuring that a preliminary evaluation of the applicant is conducted in order to establish the necessity and appropriateness of outpatient services or partial hospitalization or inpatient hospitalization service for the individual applicant. The preliminary evaluation shall be done in the least restrictive setting possible. The results of the preliminary evaluation shall be set forth on Form MH-781-A issued by the Department.

   (2)  Promptly notify the administrator if the applicant’s treatment will involve mental health/mental retardation (MH/MR) funding.

 (d)  When application is made to the administrator:

   (1)  The administrator shall designate an approved facility which shall conduct a preliminary evaluation of the applicant in order to establish the necessity and appropriateness of outpatient services or partial hospitalization service or inpatient hospitalization for the individual applicant.

   (2)  The designated facility shall immediately upon its completion of the preliminary evaluation, notify the administrator of its finding and recommendations.

   (3)  Upon receipt of the report, the administrator shall review the report and when necessary, designate an approved appropriate facility for the recommended treatment of the individual applicant.



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