Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 21 - MENTAL HYGIENE REGULATIONS
Chapter 10.21.01 - Involuntary Admission to Inpatient Mental Health Facilities
Section 10.21.01.03 - Application for Involuntary Admission (IVA)
Universal Citation: MD Code Reg 10.21.01.03
Current through Register Vol. 51, No. 19, September 20, 2024
A. An applicant for IVA shall:
(1) Have a legitimate interest in the welfare
of the individual for whom IVA is sought;
(2) Submit an application on the form
required by:
(a) The Veterans'
Administration, if the application is submitted to a Veterans' Administration
hospital; or
(b) The
Administration, if the application is submitted to an inpatient facility other
than a Veterans' Administration hospital;
(3) Fill out the appropriate form completely;
and
(4) Sign and date the
application form.
B. The Administration shall provide an application form that includes the following:
(1) The statutory authority for the
application;
(2) The form number
(DHMH34) and revision date;
(3)
Spaces for the:
(a) Name of the inpatient
facility to which the application for IVA is submitted;
(b) Name of the individual for whom IVA is
sought;
(c) Name, home or agency
address, telephone number, and relationship to the individual or official
capacity of the applicant; and
(d)
Signature of the applicant and the date that the application is made.
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