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. § 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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