Sec. 10.21.01.03. Application for Involuntary Admission (IVA)

A. An applicant for IVA shall:

(1) Have a legitimate interest in the welfare of the individual for whom IVA is sought;

(2) Submit an application on the form required by:

(a) The Veterans' Administration, if the application is submitted to a Veterans' Administration hospital; or

(b) The Administration, if the application is submitted to an inpatient facility other than a Veterans' Administration hospital;

(3) Fill out the appropriate form completely; and

(4) Sign and date the application form.

B. The Administration shall provide an application form that includes the following:

(1) The statutory authority for the application;

(2) The form number (MDH34) and revision date;

(3) Spaces for the:

(a) Name of the inpatient facility to which the application for IVA is submitted;

(b) Name of the individual for whom IVA is sought;

(c) Name, home or agency address, telephone number, and relationship to the individual or official capacity of the applicant; and

(d) Signature of the applicant and the date that the application is made.