Take a few minutes now to create a personalized template for involuntary commitment and it will make your future commitments effortless, saving you time and frustration.
Step 1: Personalize your Commitment Paperwork template
1)Open the electronic Interactive Form for ERIC and Certificate.pdf
2)Next to the line that says “Legally Responsibly Person” UNCHECK the “Next of Kin box”
3)Under “Petitioner” type your name and degree- e.g., “Donald Trump, MD”
4)Under Section 2, “Description of Findings” type the following three lines with space between them so that you can fill it in for individual patients:
Respondent is mentally ill:
Respondent is a substance abuser:
Respondent is a danger to them self/others:
5) On page 2, under “Notable Medical Conditions” type the words “See chart”
6) Under section 3 check box for “Inpatient Commitment for” and type in the number “10” in the “days” box
7)On the “Print Name of Examiner” line type in your name if it hasn’t populated already
8)Under File click “Save As” and save this template in 2 locations with slightly different names, e.g. Commitment1 and Commitment2. By saving it this one time only you will always have a backup of your personalized template in case you make the mistake of saving this file again with a patient’s information in it.
Filling out Template for Patient with Psychiatric Illness
1) Type in Patient’s name, age, date of birth, sex, race and marital status (all found in the face sheet)
2)On the “mentally ill” line in the “Description of Findings” type in the condition (e.g. “the patient suffers from Schizophrenia” or “Depression”
3)On the “substance abuser” line type in the drug(s) that they abuse. If the patient does NOT abuse drugs, highlight the line and delete it.
4)On the “danger to them self/others” line type how they are dangerous. (e.g., “they tried to kill themselves by taking an overdose of pills” or “the patient is not taking their life-saving medications for blood pressure” or “the patient is so confused that they can’t bathe, fix their own food, dress themselves” or “they threatened to stab strangers at the bus station”, etc.
5)Finally, under “Impression/Diagnosis”section Type in the Diagnosis (e.g. “Major Depression”, “Schizophrenia”, “Unspecified Psychosis”, etc.)
Print your form and sign your Physician Signature on the ERIC as well as the Petition which is supposed to be signed in the presence of a Notary. Hand these two forms to the appropriate person who will fax it to the Magistrate for approval. DO NOT PLACE A PATIENT LABEL ON THESE LEGAL FORMS- IT MAKES THEM INVALID.
BEWARE:
When you go to close the document, the PDF program will ask you “Do you want to save changes…..” Make sure you always click “NO”. Otherwise, you will overwrite your personalized template with this patient’s personal information included in it forever.
The Discharge planners on 6B should be able to answer any questions you may have.
Filling out Template for Patient with Substance Abuse
(Petitioning to Detox)
1)Type in Patient’s name, age, date of birth, sex, race and marital status (all found in the face sheet)
2)Under “Findings” delete the sentence “Respondent is mentally ill”
3)On the “substance abuser” line type in the drug(s) that they abuse. E.g., “this patient is using cocaine” Try to quantify how much they abuse the substance as well as the type(s)
4)On the “danger to them self/others” line type how they are dangerous. (e.g., “they tried to kill themselves by taking an overdose of pills while drunk” or “the patient is driving while under the influence” or “they fell and broke their arm while drunk” or “the patient tried to assault family/staff while intoxicated” or “patient is dying from liver failure due to alcohol poisoning”, etc.
5)Finally, under “Impression/Diagnosis” section Type in the Diagnosis
(e.g. “Alcohol Dependence”, “Cocaine Abuse”, “Narcotic Dependence”, etc.)