Commitment Forms

Below are commitment forms that were cooperatively drafted by a committee of probate judges and SCDMH and implemented in 2018. The forms are in a fillable Word format. 

• • Memorandum to Hospitals and Mental Health Facilities
  • M-130: Affidavit for Involuntary Emergency Hospitalization for Mental Illness and Order of Detention
  • M-131: Certificate of Licensed Physician Examination for Emergency Admission
  • M-132: Designated Examiner for Mental Illness Report
  • M-133: Notification of Emergency Admission Appointment of Designated Examiners
  • M-134: Aff for Inv Emg Hosp for Chemical Dependency
  • M-136: Part II Certificate of licensed Physician Medical Examination for Chemical Dependency
  • M-137: Report of Designed Examiner for Chemical Dependency
  • M-138: Notification of Emergency Adm for Chemical Dependency