Pennsylvania Code
Title 55 - HUMAN SERVICES
Part VII - Mental Health Manual
Subpart C - Administration and Fiscal Management
Chapter 5100 - MENTAL HEALTH PROCEDURES
MENTAL HEALTH REVIEW OFFICER AND PROCEEDINGS
Section 5100.23 - Written application, petitions, statements and certifications
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Written application, petitions, statements and certifications required under this chapter shall be made upon forms issued or approved by the Department.
(b) The forms listed in § 5100.41 (relating to forms) have been issued by the Department, and their use is mandated. No substitute for such forms is permitted without prior written authorization of the Deputy Secretary of Mental Health.
(c) Other forms required under this chapter may be developed by the administrator or the facility, but are subject to the approval of the Department.
(d) Unsworn falsification-all statements written under all applications, petitions and certifications required under the act on Departmentally issued or approved forms MH 781, 783, 784, 785, 786 and 787, shall contain the following notice-old forms may be utilized until the supply is exhausted:
ANY PERSON WHO KNOWINGLY PROVIDES ANY FALSE INFORMATION WHEN COMPLETING THIS FORM MAY BE SUBJECT TO PROSECUTION.
(e) When a person is admitted for voluntary treatment and only when no part of his treatment is provided with public funds, the new voluntary admission Form MH-788 may be used. This form will be identical to Form MH-781 with the exception that the notice concerning the penalty for giving false information will be deleted. Until form MH-788 is printed and distributed, existing Form MH-781 may be utilized for this group of persons. Each facility may make the necessary deletion on Form MH-781 to conform with section 110(c) of the act (50 P. S. § 7110(c)).
(f) Submission to county administrator: