Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VII - Mental Health Manual › Subpart C - Administration and Fiscal Management › Chapter 5100 - MENTAL HEALTH PROCEDURES › MENTAL HEALTH REVIEW OFFICER AND PROCEEDINGS › Section 5100.23 - Written application, petitions, statements and certifications

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Written
					 application, petitions, statements and certifications required under this
					 chapter shall be made upon forms issued or approved by the
					 Department.
(b) The forms listed in
					 §
											5100.41 (relating to forms) have
					 been issued by the Department, and their use is mandated. No substitute for
					 such forms is permitted without prior written authorization of the Deputy
					 Secretary of Mental Health.
(c)
					 Other forms required under this chapter may be developed by the administrator
					 or the facility, but are subject to the approval of the Department.
(d) Unsworn falsification-all statements
					 written under all applications, petitions and certifications required under the
					 act on Departmentally issued or approved forms MH 781, 783, 784, 785, 786 and
					 787, shall contain the following notice-old forms may be utilized until the
					 supply is exhausted:
ANY PERSON WHO KNOWINGLY PROVIDES ANY FALSE INFORMATION
						WHEN COMPLETING THIS FORM MAY BE SUBJECT TO PROSECUTION.
(e) When a person is admitted for voluntary
					 treatment and only when no part of his treatment is provided with public funds,
					 the new voluntary admission Form MH-788 may be used. This form will be
					 identical to Form MH-781 with the exception that the notice concerning the
					 penalty for giving false information will be deleted. Until form MH-788 is
					 printed and distributed, existing Form MH-781 may be utilized for this group of
					 persons. Each facility may make the necessary deletion on Form MH-781 to
					 conform with section 110(c) of the act (50 P. S. §
												7110(c)).
(f) Submission to county administrator:
(1) Except as set forth in paragraphs
					 (2)-(5), Forms MH 781, 783, 784, 785, 786 and 787, shall be provided to the
					 administrator under section 110 of the act (50 P. S. §
													7110).
(2) No Form MH-788 need be provided to the
					 administrator on behalf of a patient admitted for voluntary treatment when
					 reimbursement for treatment provided the patient will not include public
					 monies. This shall not affect in any way the applicability to such patients of
					 the rights and procedures afforded voluntary patients by the act and this
					 chapter. For admission to a State facility forms must be provided to the
					 administrator.
(3) The
					 administrator shall review all applications, petitions, statements and
					 certifications provided to the administrator's office to determine whether the
					 services needed are available and to assure a continuity of care.
(4) The administrator may designate a place
					 other than his office for filing of the forms mentioned in this
					 section.
(5) Mental health
					 facilities shall file such statistical reports of activities and services
					 required by the act and the Mental Health and Mental Retardation Act of 1966 as
					 the Department from time to time may require, so long as the data does not
					 identify individual patients.