CA MH 302 2004 free printable template
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State of California Health and Human Services Agency Department of Mental Health DETAINMENT ADVISEMENT My name is I am a (Peace Officer, etc.) with (Name of Agency). You are not under criminal arrest,
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How to fill out CA MH 302
How to fill out CA MH 302
01
Obtain the CA MH 302 form from the appropriate state agency or website.
02
Fill in your personal information, including your name, address, date of birth, and contact information.
03
Provide detailed information about your mental health history, including any diagnosis or treatments you have received.
04
Include information regarding any medications you are currently taking or have taken in the past.
05
Sign and date the form to certify that the information provided is accurate.
06
Submit the completed form according to the instructions provided by the state agency, which may include mailing it to a specific address or submitting it online.
Who needs CA MH 302?
01
Anyone applying for a mental health evaluation, treatment, or related services in California.
02
Professionals conducting assessments for mental health purposes.
03
Caregivers or guardians of individuals seeking mental health support.
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People Also Ask about
How do I put someone on a 5150 hold?
It must be a police officer, a mental health professional that is authorized in their county, or a licensed member of a crisis team. Any one of these professionals can order a 5150. A person in a hospital setting may also be able to initiate the process by contacting the proper authorized individuals to take action.
What does it mean to be declared 5150?
5150 is the number of the section of the Welfare and Institutions Code, which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a 72- hour psychiatric hospitalization when evaluated to be a danger to others, or to himself or herself, or gravely disabled.
What is a 72 hour hold in California?
In California, law enforcement officers and mental health professionals can place a patient on an emergency 72-hour hold, or “5150”, if, due to a mental illness, they are determined to pose a danger to themselves (DTS), a danger to others (DTO), or they are “gravely disabled” (GD).
What is the 5150 case law?
Section 5150 provides as follows: " When any person, as a result of mental disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, designated members of a mobile crisis
What is a 5150 hold in San Bernardino County?
What is a 5150? Welfare & Institutions 5150 code is a legal hold imposed on a person who, as a result of a mental health disorder, is believed to be a danger to self, a danger to others or gravely disabled.
What are the 3 reasons for 5150?
In California, law enforcement officers and mental health professionals can place a patient on an emergency 72-hour hold, or “5150”, if, due to a mental illness, they are determined to pose a danger to themselves (DTS), a danger to others (DTO), or they are “gravely disabled” (GD).
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What is CA MH 302?
CA MH 302 is a form related to mental health services in California, typically used for reporting certain information regarding mental health care practices.
Who is required to file CA MH 302?
Mental health service providers and organizations that offer specific mental health services in California are required to file CA MH 302.
How to fill out CA MH 302?
To fill out CA MH 302, individuals or organizations must provide specific data as outlined in the form's instructions, ensuring all required fields are completed accurately.
What is the purpose of CA MH 302?
The purpose of CA MH 302 is to collect data for the analysis and oversight of mental health services, ensuring compliance with state regulations and standards.
What information must be reported on CA MH 302?
Information reported on CA MH 302 typically includes details about the services provided, client demographics, and any relevant treatment outcomes.
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