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
  • M-013: Petition For Judicial Admission of a Child
  • M-014: Notice of Petition for Judicial Admission & Notice of Right to Counsel
  • M-015: Application for Child in Need of Emergency Admission
  • M-017: Part II Certificate of Licensed Physician Examination of Child in Need of Emergency Admission
  • M-019: Report of Designated Examiner for a Child