Detention Form PDF Details

In September 2010, a comprehensive guide was introduced to streamline the process for civil involuntary detention, aimed at addressing mental health, alcohol, and drug emergencies. This guide comprises a wide array of forms, each designed for specific steps within the detention and treatment procedures, ensuring that individuals in crisis receive timely and appropriate care. Among these, the DMH 128 form stands out as the initial application to the court for a 96-hour detention, evaluation, and treatment, requiring affidavits and a witness list, and necessitating notarization. This procedure is closely followed by issuing various orders for detention by the Probate Court, transportation requests, and applications for longer detention periods or the release of voluntary patients. Each form serves a unique purpose, whether it's for securing immediate attention for individuals presenting a likelihood of serious harm to themselves or others, facilitating subsequent legal proceedings, or setting conditions for release. The meticulous documentation and court involvement underscore the system's dedication to balancing individual rights with the public interest in safety and health. This infrastructure not only guides the immediate response to crises but also outlines the pathway towards extended care or release, ensuring a comprehensive approach to involuntary detention and rehabilitation.

QuestionAnswer
Form NameDetention Form
Form Length48 pages
Fillable?No
Fillable fields0
Avg. time to fill out12 min
Other namesmissouri form dmh 132, missouri 96 hour hold paperwork, facility issued osca online, involuntary detention forms printable

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REFERENCE GUIDE FOR

CIVIL INVOLUNTARY DETENTION:

FORMS

DIVISION OF

COMPREHENSIVE PSYCHIATRIC SERVICES

September 2010

 

LIST OF CIVIL INVOLUNTARY DETENTION FORMS:

 

 

 

 

 

 

 

MENTAL HEALTH AND ALCOHOL AND DRUG

 

 

 

 

 

DMH 128

Application to Court for 96 Hour Detention, Evaluation and Treatment/Rehabilitation

 

Used to apply to court for 96 hour detention for mental health and alcohol and drug

 

Completed by any adult person

 

Must have Affidavits (DMH 142) and Witness List (DMH 137) attached

 

Must be notarized

 

Presented to the Probate Court in the county where the person may be found

 

Copies provided within 3 hours to the Client

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

*DMH 129

Order for 96 Hour Detention, Evaluation and Treatment/Rehabilitation

 

Order for 96 hour detention for mental health and alcohol and drug

 

Issued by the Probate Court in the county where the person may be found

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

*OSCA MH15

Order for 96 Hour Detention, Treatment and Rehabilitation and Warrant (MH)

 

Order for 96 hour detention for mental health only

 

Plus a Warrant for Law Enforcement to assume custody and transport

 

Issued by the Probate Court in the county where the person may be found

 

Executed and signed by the Sheriff

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

*OSCA MH20

Order for 96 Hour Detention, Treatment and Rehabilitation and Warrant (A&D)

 

Order for 96 hour detention for alcohol and drug only

 

Plus a Warrant for Law Enforcement to assume custody and transport

 

Issued by the Probate Court in the county where the person may be found

 

Executed and signed by the Sheriff and returned to the Probate Court

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

*DMH 130

Warrant

 

Warrant for Law Enforcement to assume custody and transport

 

Issued by the Probate Court in the county where the person may be found

 

Executed and signed by the Sheriff and returned to the Probate Court

DMH 131

Request for Transportation to Mental Health Facility/Alcohol and Drug Abuse Facility

 

Mental Health Coordinator form to request transportation by law enforcement

DMH 132

Application for 96 Hour Imminent Harm Admission to Mental Health/Alcohol & Drug Abuse Facility

 

Used to apply for 96 hour detention for mental health and alcohol and drug

 

Completed by Peace Officer or Facility Designee

 

Must have Affidavits (DMH 142) and Witness List (DMH 137) attached

 

Must be notarized

 

Presented to the Head of the Facility

 

Copies provided within 3 hours to the Client

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

 

Application for 96 Hour Detention, Evaluation, and Treatment/Rehabilitation of a Voluntary Patient

DMH 133

Requesting Release

 

Used to apply for 96 hour detention for mental health and alcohol and drug for a voluntary client who is

 

requesting release

 

Completed by Facility Designee

 

Must have Affidavits (DMH 142) and Witness List (DMH 137) attached

 

Must be notarized

 

Presented to the Head of the Facility

 

1

 

 

 

Copies provided within 3 hours to the Client

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

DMH 134-1

Petition for Involuntary Detention and Treatment

 

Used to apply for detention beyond 96 hours for mental health and alcohol and drug

 

Completed by Facility Designee

 

Must have Verification (DMH 134-2) and Witness List (DMH 137) attached

 

Original presented to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, Prosecuting Attorney and Department of Mental Health

 

Court will serve the Client and the Client’s Attorney with the Petition

DMH 134-2

Verification

 

Used with Petition (DMH 134-1 to apply for detention beyond 96 hours for mental health and alcohol

 

and drug

 

For mental health, completed by: 1) a psychiatrist or by 2) a licensed physician and a mental health

 

professional

 

For alcohol and drug, completed by a licensed physician

 

Original presented to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client, Client’s Attorney, Prosecuting Attorney and Department of Mental

 

Health

*DMH 135

Order Setting Hearing on Application for Additional Detention and Treatment and Confirming

 

Issued by the Probate Court setting the date and time for the hearing, continuing the service of the

 

attorney and ordering all records made available to the attorney for mental health and alcohol and

 

drug

 

Copies distributed by the Probate Court. The facility should ensure that copies go to the Client,

 

Client’s Chart , Client’s Attorney, Department of Mental Health

*OSCA MH25

Order Setting Hearing on Petition for Additional Detention and Treatment and Confirming

 

Issued by the Probate Court setting the date and time for the hearing, continuing the service of the

 

attorney and ordering all facility records made available to the attorney for mental health only (OSCA

 

form)

 

Copies distributed by the Probate Court. The facility should ensure that copies go to the Client,

 

Client’s Chart , Client’s Attorney, Department of Mental Health

*OSCA MH30

Order Setting Hearing on Petition for Additional Detention and Treatment and Confirming

 

Issued by the Probate Court setting the date and time for the hearing, continuing the service of the

 

attorney and ordering all facility records made available to the attorney for alcohol and drug only

 

(OSCA form)

 

Copies distributed by the Probate Court. The facility should ensure that copies go to the Client,

 

Client’s Chart , Client’s Attorney, Department of Mental Health

*DMH 136

Judgment for Involuntary Inpatient Detention and Treatment/Rehabilitation

 

Issued by the Probate Court order further detention for mental health and alcohol and drug

 

Copies distributed by the Probate Court. The facility should ensure that copies go to the Client,

 

Client’s Chart , Client’s Attorney, Department of Mental Health

*OSCA MH35

Judgment for Involuntary Detention and Treatment (MH)

 

Issued by the Probate Court order further detention for mental health only (OSCA form)

 

Copies distributed by the Probate Court. The facility should ensure that copies go to the Client,

 

Client’s Chart , Client’s Attorney, Department of Mental Health

*OSCA MH40

Judgment for Involuntary Detention and Treatment (A&D)

 

Issued by the Probate Court order further detention for alcohol and drug only (OSCA form)

 

Copies distributed by the Probate Court. The facility should ensure that copies go to the Client,

 

Client’s Chart , Client’s Attorney, Department of Mental Health

DMH 137

List of Witnesses

 

Completed for all 96 hour applications; Court DMH 128, Imminent Harm DMH 132, Voluntary to

 

Involuntary DMH 133 and Petition DMH 143-1 for mental health and alcohol and drug

 

Completed by the applicant

 

Lists names, addresses and telephone numbers of any prospective witnesses

 

Presented to the Probate Court with a DMH 128 or DMH 134-1 Application

 

2

 

Presented to the Head of the Facility with a DMH 132 or DMH 133 Application

 

Copies to Medical Record, Client’s Attorney, Prosecuting Attorney and Department of Mental Health

 

Court will serve the Client and the Client’s Attorney with the List of Witnesses

DMH 138

Notice of Admission of Involuntary Patient

 

Completed by the Head of the Facility upon the admission of an involuntary client for mental health

 

and alcohol and drug

 

Copies provided within 3 hours to the Client

 

Provides the date of admission, proof that notice of rights was given and name of the attorney

 

designated from the list provided by the Probate Court

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

DMH 139

Withdrawal Petition (MH)

 

Completed by the applicant, most usually the Head of the Facility, withdrawing the petition for further

 

detention and stating the reasons why for mental health

 

Presented to the Probate Court in the county where the facility is along with DMH 147 Notice of

 

Discharge/Voluntary Admission

 

Copies to Client, Medical Record, Client’s Attorney, Prosecuting Attorney and Department of Mental

 

Health

DMH 8537

Withdrawal Petition (A&D)

 

Completed by the applicant, most usually the Head of the Facility, withdrawing the petition for further

 

detention and stating the reasons why for alcohol and drug

 

Presented to the Probate Court in the county where the facility is along with DMH 147 Notice of

 

Discharge/Voluntary Admission

 

Copies to Client, Medical Record, Client’s Attorney, Prosecuting Attorney and Department of Mental

 

Health

DMH 140

Application for Order Appointing Independent Physician/Psychologist

 

Filed by the client’s attorney requesting the Probate Court to appoint a licensed physician or

 

psychologist to examiner the client and testify on his behalf at hearings for detention beyond 21 days

 

for mental health only

*DMH 141

Order Appointing Independent Physician/Psychologist

 

Issued by the Probate Court appointing a licensed physician or psychologist to examiner the client and

 

testify on his or her behalf at hearings for detention beyond 21 days for mental health only

*OSCA MH45

Order Appointing Independent Physician/Psychologist

 

Issued by the Probate Court appointing a licensed physician or psychologist to examiner the client and

 

testify on his or her behalf at hearings for detention beyond 21 days for mental health only (OSCA

 

form)

DMH 142

Affidavit in Support of Application for Detention, Evaluation and Treatment/Rehabilitation –

 

Used to support an application (DMH 128, DMH 132, DMH 133) for 96 hour detention for mental

 

health and alcohol and drug

 

Completed by any adult person

 

Describes the behavior that supports that the client presents a likelihood of serious harm as the result

 

of mental disorder or alcohol or drug abuse

 

Must describe behavior that supports the presence of a mental disorder and the likelihood of

 

harm as the result of the mental disorder

 

Must be notarized

 

Presented to the Probate Court with a DMH 128 Application

 

Presented to the Head of the Facility with a DMH 132 or DMH 133 Application

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

*DMH 143

Notice of Hearing on Petition for Additional Detention and Treatment

 

Issued by the Probate Court providing notice to the client and the client’s attorney that a petition for

 

further detention has been filed and provides the date and time of the hearing for mental health and

 

alcohol and drug

 

Served by the Sheriff

*OSCA MH26

Notice of Hearing on Petition for Additional Detention and Treatment (MH)

 

3

 

Issued by the Probate Court providing notice to the client and the client’s attorney that a petition for

 

further detention has been filed and provides the date and time of the hearing for mental health only

 

Served by the Sheriff (OSCA form)

*OSCA MH31

Notice of Hearing on Petition for Additional Detention and Treatment (A&D)

 

Issued by the Probate Court providing notice to the client and the client’s attorney that a petition for

 

further detention has been filed and provides the date and time of the hearing for alcohol and drug

 

only

 

Served by the Sheriff (OSCA form)

DMH 145

Notice of Rights of Involuntary Patient

 

Presented to any person admitted for 96 hour detention for mental health and alcohol and drug

 

Must be presented within to client 3 hours of admission

 

Provided within 8 hours to guardian or with consent to family

 

A staff member must have the client read the rights or must read the rights to the person

 

The staff member must sign the form

 

Copies sent within 24 hours to the Probate Court in the county where the facility is

 

Copies to Medical Record, Client’s Attorney, and Department of Mental Health

*DMH 146

Order for Release

 

Issued by the Probate Court when the client is found not to meet criteria for further detention for

 

mental health and alcohol and drug

*OSCA MH50

Order for Release (MH)

 

Issued by the Probate Court when the client is found not to meet criteria for further detention for

 

mental health only (OSCA form)

*OSCA MH55

Order for Release (A&D)

 

Issued by the Probate Court when the client is found not to meet criteria for further detention for

 

alcohol and drug only (OSCA form)

DMH 147

Notice of Discharge/Voluntary Admission (MH)

 

Completed by the Head of the Facility to notify the Probate Court of the client’s discharge or voluntary

 

admission for mental health

 

Ends the commitment

 

Copies sent to the Probate Court in the county where the facility is

 

Copies to Client, Medical Record, Client’s Attorney, and Department of Mental Health

DMH 8543

Notice of Discharge/Voluntary Admission (A&D)

 

Completed by the Head of the Facility to notify the Probate Court of the client’s discharge or voluntary

 

admission for alcohol and drug

 

Ends the commitment

 

Copies sent to the Probate Court in the county where the facility is

 

Copies to Client, Medical Record, Client’s Attorney, and Department of Mental Health

DMH 148

Request for Change of Venue to Respondent's County of Residence (MH)

 

Presented to the Probate Court requesting that the hearing for further detention be held in the client’s

 

county of residence for mental health

 

Completed by the client, or the client’s parent or guardian or attorney

DMH 8544

Request for Change of Venue to Respondent's County of Residence (A&D)

 

Presented to the Probate Court requesting that the hearing for further detention be held in the client’s

 

county of residence for alcohol and drug

 

Completed by the client, or the client’s parent or guardian or attorney

DMH 149

Order for Change of Venue to Respondent's County of Residence (MH)

 

Issued by the Probate Court ordering that the hearing for further detention be held in the client’s

 

county of residence for mental health

DMH 8545

Order for Change of Venue to Respondent's County of Residence (A&D)

 

Issued by the Probate Court ordering that the hearing for further detention be held in the client’s

 

county of residence for alcohol and drug

DMH 150

Conditional Release for Involuntarily Detained Patient

 

Used to place a detained client on conditional release in the community for mental health

 

Completed by the Head of the Facility and signed by the client and mental health professional

 

Specifics conditions of release, follow-up care and the provider

 

4

 

Copies sent to the Probate Court in the county where the facility is

 

Copies to Client, Medical Record, Client’s Attorney, and Department of Mental Health

DMH 151

Notice to Patient of Revocation of Conditional Release

 

Used by the Head of the Facility to revoke the conditional release

 

The Probate Court may order the law enforcement to detain and transport the client the mental health

 

facility

 

The Probate Court may order a hearing on the revocation of conditional release

 

Copies sent to the Probate Court in the county where the facility is

 

Copies to Client, Medical Record, Client’s Attorney, and Department of Mental Health

DMH 152

Request for Hearing on Revocation of Conditional Release

 

Completed by the client to request that the Probate Court hold a hearing on the revocation of

 

conditional release

DMH 153

Trial Visit for Involuntarily Detained Patient

Used for a trial visit to the community for a detained for mental health

Completed by the Head of the Facility and signed by the client

Copies sent to the Probate Court in the county where the facility is

Copies to Client, Medical Record, Client’s Attorney, and Department of Mental Health

* DENOTES PROBATE COURT ORIGINATED FORMS

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