Md. Code Regs. 10.21.01.03

Current through Register Vol. 51, No. 12, June 14, 2024
Section 10.21.01.03 - Application for Involuntary Admission (IVA)
A. An applicant for IVA shall:
(1) Have a legitimate interest in the welfare of the individual for whom IVA is sought;
(2) Submit an application on the form required by:
(a) The Veterans' Administration, if the application is submitted to a Veterans' Administration hospital; or
(b) The Administration, if the application is submitted to an inpatient facility other than a Veterans' Administration hospital;
(3) Fill out the appropriate form completely; and
(4) Sign and date the application form.
B. The Administration shall provide an application form that includes the following:
(1) The statutory authority for the application;
(2) The form number (DHMH34) and revision date;
(3) Spaces for the:
(a) Name of the inpatient facility to which the application for IVA is submitted;
(b) Name of the individual for whom IVA is sought;
(c) Name, home or agency address, telephone number, and relationship to the individual or official capacity of the applicant; and
(d) Signature of the applicant and the date that the application is made.

Md. Code Regs. 10.21.01.03

Regulations .03 adopted effective September 28, 1992 (19:19 Md. R. 1708)