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PRINTED: 10/13/2021 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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The 1013 form approved is a document for requesting a psychiatric evaluation and admission for individuals who are deemed a danger to themselves or others.
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Qualified medical professionals such as licensed physicians, psychiatrists, or psychologists are required to file the 1013 form approved.
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To fill out the 1013 form approved, the medical professional must provide detailed information about the individual's mental health status and the reasons for requesting evaluation and admission.
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The purpose of the 1013 form approved is to ensure that individuals in mental health crisis receive timely evaluation and treatment to prevent harm to themselves or others.
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The 1013 form approved must include the individual's personal information, mental health history, current mental status, and the medical professional's assessment indicating the need for evaluation and admission.
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