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Client Placement Forms

The Division of Substance Abuse and Mental Health has provided the following list of Client Placement Forms:

Emergency Admissions

  • 24 Hour Emergency Admission Form (Updated February 04, 2008)
    To be used for 24 hour commitments and must be completed prior to presenting to the admitting physician. Text - 24-hour form
  • Civil Commitment Form (Added April 16, 2007)
    The Civil Commitment is to be completed only by a psychiatrist and may be used to hospitalize a person who is deemed to be a threat to himself, others or property or to hospitalize a person who is unable to make responsible decisions about his or her treatment and care. Text - Civil Commit Form

CRF Forms

  • Consumer Reporting Form (CRF) Admissions (Updated August 10, 2006)
    The Consumer Reporting Form (CRF ) is a data collection tool that provides information about clients in DSAMH-funded programs. This form is used at admission to the treatment unit. Mental health programs use the five axis DSM-IV diagnosis form in addition to the two page admission and the two page discharge forms. By using the CRF to obtain demographic and background information on clients, DSAMH can better understand the clients who utilize its services. DSAMH also uses the CRF form to assess its success in treating community and inpatient populations. Text - CRF.
  • Consumer Reporting Form (CRF) Discharge  (Updated August 10, 2006)
    This form is used during discharge from the treatment unit.Text - CRF Discharge.
  • Instructions and Code Sheet for CRF (Updated May 15, 2006) Text - CRF Instructions

EEU Forms

Discharge and Transfer Forms

Certification Forms


Some of the files above are in Adobe Acrobat format. You can view them with Adobe Acrobat Reader. For your free copy please visit Acrobat Download Adobe Acrobat Reader If you are using an assistive technology unable to read Adobe PDF, please visit Adobe's Accessibility Tools page.

Last Updated: Tuesday February 26 2008
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