Notification--Emergency Detention NO. ____________________ DATE:_______________ TIME:_______________
THE STATE OF TEXAS
FOR THE BEST INTEREST AND PROTECTION OF:
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NOTIFICATION OF EMERGENCY DETENTION
Now comes _____________________________, a peace officer with (name of agency) _____________________________, of the State of Texas, and states as follows:
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For the above reasons, I present this notification to seek temporary admission to the (name of facility) _________________________ inpatient mental health facility or hospital facility for the detention of (name of person to be detained) __________________________ on an emergency basis.
_________________________ BADGE NO. _____________________
PEACE OFFICER'S SIGNATURE
Address: _________________________ Zip Code: ____________________
Telephone: ______________________
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SIGNATURE OF EMERGENCY MEDICAL SERVICES PERSONNEL (if applicable)
Address: _________________________ Zip Code: ____________________
Telephone: ______________________
A mental health facility or hospital emergency department may not require a peace officer or emergency medical services personnel to execute any form other than this form as a predicate to accepting for temporary admission a person detained by a peace officer under Section 573.001, Health and Safety Code, and transported by the officer under that section or by emergency medical services personnel of an emergency medical services provider at the request of the officer made in accordance with a memorandum of understanding executed under Section 573.005, Health and Safety Code.
Tex. Health and Safety Code § 573.002