Trouble Viewing a PDF?
For information on how to view PDF files, please look over our suggestions on the Viewing PDF Files page.
Please note that some browsers may not open our PDF forms correctly, or at all. Please follow our helpful tips for opening and completing PDF forms.
Mental Hygiene Involuntary Commitment Forms
REVISED Forms are indicated below. Destroy old forms in your possession and replace with REVISED Forms below.
Form No. | Description of Form | Signatory |
---|---|---|
INV 1 | Application for Involuntary Custody for Mental Health Examination | Applicant |
INV 1M | Application for Involuntary Custody for Mental Health Examination of Minor | Chief Medical Officer (under oath) |
INV 2 | Application for Incarcerated Individual's Mental Health Examination under WV Code 27-5-2 | Chief Administrative Officer of Correctional Facility (under oath) |
INV 8 | Motion to Withdraw Application for Involuntary Custody for Mental Health Examination | Applicant |
INV 10 | Certificate of Licensed Examiner | Physician/Psychologist/Ct. Approved Licensed Clinical Social Worker/Ct. Approved Advanced Nurse Practitioner/Physician Assistant |
INV 14 | Voluntary Treatment Agreement (VTA) | Respondent + Counsel for Resp. + MHC/Judge/Magistrate |
INV 16 | Motion for Hospitalization Due to Noncompliance with VTA | Mental Health Center or Other Movant |
INV 21 | Motion for Cancellation or Modification of VTA | Conservator/Guardian; Notary |
INV 26 | Chief Medical Officer's Application for Final Commitment | Chief Medical Officer |
INV 39 | Order to Return Escaped Patient to Facility | Chief Medical Officer of Mental Health Facility |
INV 40 | Report of Discharge of Patient | Chief Medical Officer of Mental Health Facility |
INV 41 | Attestation of Physician:Ordering Involuntary Hospitalization (72 hour hold) | Hospital Physician |
Court Contacts | Mental Hygiene Court Contacts | Hosptal Resources |
EXAM 1 | Petition for Court Authorization to Perform Examinations for Probable Cause Proceedings for Involuntary Hospitalization | Licensed In dependent Clinical Social Worker or Advanced Nurse Practitioner with Psychiatric Certification |
EXAM 4 | Report/Request of Court Authorized Examiner Regarding Licensing Change | Licensed Independent Clinical Social Worker or Advanced Nurse Practitioner with Psychiatric Certification |