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Get CA DHCS 1801 2014

___ I am a (Peace Officer, etc.) with (Name of Agency). You are not under criminal arrest, but I am taking you for examination by mental health professionals at (Name of Facility). See California W&I Code Section 5328 and HIPAA Privacy Rule 45 C.F.R. ยง 164.508 You will be told your rights by the mental health staff. APPLICATION FOR ASSESSMENT, EVALUATION, AND CRISIS INTERVENTION OR PLACEMENT FOR EVALUATION AND TREATMENT Welfare and Institutions Code (W&I Code), Section 5150(f) and (g), requ.

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