M-Forms

M-Forms are required for involuntary services under Article 65 of Title 27 of Colorado Revised Statutes, which explains how mental health services should be given. BHA makes sure the rules and laws are followed properly. That way, everyone treated has their rights protected. This table describes how and when to use each M-Form.

To view and download a form, click on the title below.

Number	Title	When to Use	Age Requirement	Other Important Information
0.5	Involuntary Emergency Transportation Hold	Involuntarily transporting an individual to an emergency department or designated facility. Probably cause the individual is experiencing a behavioral health crisis or is gravely disabled. Without further intervention the person may be a danger to self or others.	All ages	Not to be used to transfer individual between facilities; please use M-18.2 for those needs.
0.51	Transportation Patient Rights	Provided to the individual prior to the individual being involuntarily transported under the "Transportation Hold" (M-0.5).	All ages	Available in Spanish.
1	Emergency Mental Health Hold Application	Application to involuntarily hold an individual for up to 72 hours. Individual must be a danger to self, danger to others, or gravely disabled due to a mental health disorder. Individuals may be held in a 27-65 designated facility or emergency department. Individuals may NOT be held in lock up, jail, or other places where persons are detained for penal offenses.	All ages	Subsequent Holds: EMERGENCY DEPARTMENTS ONLY An individual may be placed on a subsequent hold if: 1. Individual continues to meet hold criteria. 2. Placement cannot be located or is delayed. 3. BHA Care Coordination must be notified. Available in Spanish.
1.1	Subsequent Hold Court Notification	Emergency Departments must submit to the court of jurisdiction when a subsequent hold is placed. Court will immediately appoint an attorney for the individual on the hold.	All ages	BHA must be notified after EACH subsequent hold.
2	Patient Rights: Emergency Mental Health Hold	Provided when application for emergency mental health hold is initiated. Must be provided in written and verbal form.	All ages	Rights should be advised again whenever a subsequent hold is utilized. Available in Spanish.
2.1	Voluntary Advisement	Designated Facilities only: During emergency mental health hold, individual is offered and accepts voluntary services.	All ages	Must be provided in written and verbal form.
2.2	Patient Rights - Voluntary Minor Hospitalization	Individual is a minor (under 18 yrs) and voluntarily seeks hospitalization. Designated Facilities only.	under 18 years	Minors 15-17 years do not require parent/guardian consent hospitalization. Minors 14 years and younger must have parent/guardian consent to seek voluntary hospitalization. Available in Spanish.
3	Order for Emergency Screening	Order issued by county court following M-4 Petition. Initiates a screening of the individual to determine if they meet emergency hold criteria.	All ages	Court order will identified which party (peace officer, designated facility, or professional person) must complete the screening and disposition.
3.1	Notice of Disposition	Submitted to the court by the designated facility or emergency department that completed evaluation following the court ordered evaluation (M-7). Individual is NOT certified for short-term treatment.	All ages
3.5A	Request for Care Coordination	To assist with placement for individuals transferring from criminal court to civil court. Submitted to BHA Care Coordination. Must be accompanied by M-3.5B.	All ages	This pathway is NOT for competency restoration.
3.5B	Order for Petition	Court issued order to disclose private health information to BHA Care Coordination. Submitted to BHA Care Coordination, must accompany M-3.5A.	All ages
4	Petition for Emergency Mental Health Hold	Submitted to the court to request an evaluation of an individual's condition. Petition must show sufficient evidence the individual has a mental health disorder AND is a danger to self, a danger to others, or is gravely disabled.	All ages	Any person with a personal connection to the individual in question may submit the petition.
5	Notice Of Screening	After receiving court ordered screening (M-3), a facility will provide notice to the individual named in the court order.	All ages	Court order will identify designated facility, emergency department or crisis response team to complete the screening.
6	Screening Report	Submitted to the court following the completion of the screening (M-3).	All ages
7	Order for Evaluation	Court issued order for a designated facility to evaluate individual. This is sometimes called a "court ordered emergency mental health hold."	All ages
7.5	Standardized Evaluation	After an individual has been placed on the emergency mental health hold (M-1 or M-7), to determine next steps of treatment needs for the individual.	All ages	Per 27-65-106(6)(b), every person held involuntarily must receive this evaluation. To be used in designated facility or emergency department.
8	Notice of Short-Term Certification	Completed by the professional person at a designated facility. Submitted to the courts within 48 hours of a professional person determining the individual needs certification.	All ages	Other court documents required to be submitted to the court: M-22 Professional's Statement M-19 Request for Counsel
8.1	Patient Rights: Adult Inpatient	Provided by the designated facility to the individual upon initiation of the certification. Must be provided in both written and verbal form.	18 years and older	Inpatient Certification within a designated facility. Available in Spanish.
8.2	Patient Rights: Outpatient	Provided by the designated facility to the individual upon initiation or renewal of outpatient certification. Must be provided in both written and verbal form.	All ages	Outpatient Certification held by designated facility. Available in Spanish.
8.3	Patient Rights: Minor Certification	Provided by the designated facility to the individual upon initiation of the certification. Must be provided in both written and verbal form.	under 18 years	Inpatient Certification within a designated facility. Available in Spanish.
8.4	Order for Incompetent to Proceed to Short-Term Certification	Court issued order to transfer an individual from the criminal court system to the civil court system and initiate a short-term certification at a designated facility.	All ages
8.5	Objection to Hospitalization of Minors	Certified minor or minor hospitalized with parental consent (14 years and younger), objects to hospitalization or aspects of their treatment (including medications or special procedures). Form is completed by designated facility or minor's attorney and submitted to the court.	Under 18 years- any certified minor 14 years and younger- placed by parent/guardian consent	Can also be used to request services be moved to outpatient. Available in Spanish.
9	Notice Of Transfer	Submitted to the court of jurisdiction when certification and/or person is transferred to another designated facility for continued care and treatment under the certification.	All ages
10	Notice of Termination of Certification	Submitted to the court of jurisdiction when the professional person in charge of the certification determines the individual no longer meets certification criteria.	All ages	Must also notify BHA prior to certification termination.
11	Extended Certification for Short-Term Treatment	Submitted to courts to notify the individual's certification has been extended for an additional three months.	All ages	Submitted with M-22 (professional's statement). Individual shall be provided their patient rights verbally and in writing (M-8.1 inpatient, 8.2 outpatient).
12	Petition for Long-Term Certification	Submitted to courts. Professional person believes individual's condition requires continued treatment beyond a short-term certification.	All ages	Submitted with M-22.
13	Order for Long-Term Certification	Court issued order for long-term treatment and care.	All ages
14	Petition for Extension of Long-Term Certification	Submitted to courts. Professional person believes individual's condition requires continued treatment beyond the initial long-term certification.	All ages	Submitted with M-22.
15	Notice of Right to Hearing	Provided to the individual currently receiving involuntary services. Notifies them of their right to hearing to contest the petition for LTC or ELTC.	All ages
16	Order for Extension of Long-Term Certification	Court issued order for long-term treatment and care to be extended by an additional six month.	All ages
17	Discharge Order	Court issued order to terminate involuntary treatment and care. Completed when court denies a petition for continued involuntary care or after a hearing contesting continued involuntary treatment and care.	All ages	Designated facility must complete BHA Certification Termination Reporting when receiving this order or when voluntarily terminating treatment.
18	Order to Transport	Court issued order for individual to be transported to another designated facility for continued involuntary treatment and care.	All ages
18.1	Request for Transport of Outpatient Certification	Submitted to the courts to pick up and transport individual to designated for treatment and care.	All ages
18.2	Request for Transport Between Facilities	Submitted to courts to request secure transport from one designated facility to another for continued treatment.	All ages
19	Request for Counsel	Submitted to the courts with initial short-term certification notification.	All ages
20	Order Appointing Counsel	Court issued order identifying the attorney or GAL for the individual under certification or subsequent emergency mental health hold.	All ages
21	Petition for STC under 108.5	Submitted to the courts to request an individual be certified for short-term treatment and care.	All ages	NOT to be used for competency restoration services.
22	Professional's Statement	Submitted to the courts at every certification, extension or petition. Can also be used to request court-ordered medications or special procedures.	All ages	Must show how the individual meets certification criteria at the suggested level of care.
23	Petition for Imposition of Legal Disability	Submitted to the courts, request must prove the requested disability or deprivation is necessary and desirable for the safety of the individual.	All ages
24	Notice of Petition for Imposition of Legal Disability	Provided to the individual under petition; notifies the petition has been filed.	All ages

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