West Virginia Judiciary

Mental Hygiene Involuntary Commitment

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Mental Hygiene Involuntary Commitment Forms

REVISED Forms are indicated below. Destroy old forms in your  possession and replace with REVISED Forms below.

Mental Hygiene Involuntary Commitment Forms
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