Fillable Notification Of Emergency Detention - Texas Health And Safety Code printable pdf download

Notification--Emergency Detention

NO. ___________________________

DATE:___________________________ TIME:_______________

THE STATE OF TEXAS

FOR THE BEST INTEREST AND PROTECTION OF:

____________________________________

D.O.B.:_______________

NOTIFICATION OF EMERGENCY DETENTION

Now comes __________________________________, a peace officer with El Paso Sheriff’s Office,

of the State of Texas, and states as follows:

1. I have reason to believe and do believe that (name of person to be detained):

____________________________________________ evidences mental illness.

2. I have reason to believe and do believe that the above-named person evidences a substantial risk

of serious harm to himself/herself or others based upon the following:

_____________________________________________________________________________________________

3. I have reason to believe and do believe that the above risk of harm is imminent unless

the above-named person is immediately restrained.

4. My beliefs are based upon the following recent behavior, overt acts, attempts, statements, or

threats observed by me or reliably reported to me: _________________________________________________

____________________________________________________________________________________________

5. The names, addresses, and relationship to the above-named person of those persons who reported or

observed recent behavior, acts, attempts, statements, or threats of the above-names person are :

____________________________________________________________________________________________

For the above reasons, I present this notification to seek temporary admission to the (name of facility)

_________________________________ inpatient mental health facility or hospital facility for the detention of

(name of person to be detained)_______________________________________on an emergency basis.

6. Was the person restrained in any way? Yes □ No □

x______________________________________

BADGE NO. _________________

PEACE OFFICER'S SIGNATURE

Address: __________________________ Zip Code: ______________Telephone:_______________

A mental health facility or hospital emergency department may not require a peace officer to

execute any form other than this form as a predicate to accepting for temporary admission a

person detained under Section 573.001, Texas Health and Safety Code.

Notification Of Emergency Detention - Texas Health And Safety Code