The ADHS/DBHS Form MH-100 is Arizona's Application for Involuntary Evaluation, governed by A.R.S. § 36-520. It allows any concerned individual to request a pre-petition screening for a person believed to have a mental disorder that makes them a danger to themselves or others, or leaves them gravely or persistently disabled. The form collects the proposed patient's personal details, including age, date of birth, sex, and race, along with the applicant's stated reasons for the request. A notary public must certify the applicant's signature before the form is submitted to the county behavioral health authority. For related mental health forms, see our Superbill for Mental Health and the Abnormal Involuntary Movement Scale.
| Question | Answer |
|---|---|
| Form Name | ADHS BHS Form MH-100 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| State | Arizona |
| Legal Authority | A.R.S. § 36-520 |
| Notary Required | Yes |
| Submitted To | County behavioral health authority |
| Other names | arizona involuntary evaluation, arizona dbhs form online, arizona dbhs application, az dbhs form |