24-HOUR EMERGENCY DETENTION FORM Detainment after transfer to a designated psychiatric facility shall not exceed 24 hours. 5122 are disclosed on the DSAMH Crisis Intervention Assessment Tool and 24-hour Emergency Admission form filed with DSAMH within 24 hours of signature of the detention order. 652. 2929 Fax copy of this completed form to DSAMH Eligibility and Enrollment Unit during business hours Mon.-Fri. 7 a.m.-3 p.m. to 302. 255. 4416. Outs.
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How to fill out the DE 24-Hour Emergency Detention Form online
Completing the DE 24-Hour Emergency Detention Form online is an important and sensitive process. This guide will help you navigate each section of the form, offering clear and supportive instructions to ensure accurate completion.
Follow the steps to successfully complete the form online.
- Click the ‘Get Form’ button to access the document and open it in your preferred editor.
- In the 'Request for 24-Hour Detention' section, indicate the date and time of the request, and provide the full name, unit, and agency of the peace officer or mental health screener completing the form.
- Fill in the details of the person to be evaluated, including their full name, date of birth, age, and address. Ensure all information is accurate to facilitate proper processing.
- Assess whether the individual poses a danger to themselves or others. Mark 'YES' or 'NO' accordingly for each consideration and provide a detailed justification for any dangerousness observed.
- Once the evaluation is completed, the peace officer or mental health screener should sign, indicate their telephone number, and date the form.
- For questions 2-6, the certified mental health screener needs to assess the individual's mental condition and provide the necessary information regarding previous psychiatric hospitalizations and current treatments.
- In the conflict of interest section, disclose any potential conflicts and sign to confirm the accuracy of the stated information.
- Ensure all necessary signatures are obtained in the final sections for verification and acknowledgment.
Complete the DE 24-Hour Emergency Detention Form online to ensure timely and effective management of the evaluation process.
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