Section He-M 614.05 - Completing the Petition and Certificate(a) The petition shall be completed by the petitioner and consists of the petitioner's statement.(b) The petitioner's statement in (a) above shall be completed as follows: (1) The petitioner shall review the instructions to petitioner on page 2, and provide the following information on pages 3 and 4 of the petition and certificate: a. The name of the person sought to be admitted and the date;b. Information identifying the person sought to be admitted and whether the petitioner believes the person is or has been a danger to self or others; andc. Information identifying the petitioner and a description of specific dangerous acts or behaviors within the last 40 days by the person sought to be admitted; and(2) The petitioner shall sign the petition.(c) A statement by a witness, witness' statement, shall be completed if a witness is necessary and available to testify.(d) If a witness is available to testify, the witness's statement in (c) above shall be completed by a witness who has observed dangerous acts or behaviors by the person sought to be admitted and the witness shall provide the following information on page 5 of the petition and certificate: (1) Information identifying the witness; and(2) A statement or statements as to specific dangerous acts or behaviors within the last 40 days by the person sought to be admitted observed by the witness.(e) The physical examination shall be conducted within 3 days of the date of the completion of the petition in (a) above, as follows:(1) A licensed practitioner or their designee shall conduct a physical examination of the person sought to be admitted and provide the following information on page 6 of the petition and certificate: a. The name of the person sought to be admitted;b. Information identifying the licensed practitioner or designee such as name, title, phone number, and address;c. A detailed description of the nature of the physical examination, including a list of known past or present medical conditions, positive physical findings, and other pertinent medical information that the mental health facility may need to know; andd. A signed statement that the person sought to be admitted is medically approved for admission to a DRF; and(2) The licensed practitioner or designee shall perform such physical examination in accordance with the standard of practice applicable to the practitioner pursuant to RSA 326-B, RSA 328-D, or RSA 329, and any other applicable laws or rules to ensure that: a. The person sought to be admitted is medically stable for the level of medical care that the DRF is able to provide; andb. The individual's medical problems are not impacting their mental status in a way that interferes with diagnosing the mental illness.(f) The mental examination shall be conducted within 3 days of the completion of the petition in (a) above, as follows: (1) A licensed practitioner or designee shall conduct a mental examination of the person sought to be admitted and provide the following information on page 7 of the petition and certificate: a. The name of the person sought to be admitted;b. Information identifying the licensed practitioner or designee such as name, title, phone number, and address;c. A detailed description of the nature of the examination, including a list of any past or present mental condition, hospitalizations for psychiatric reasons, psychotropic medications, current mental status, orientation, memory, judgment, speech productiveness, coherence, emotional tone, insight, activity level, appearance, and any other pertinent information on the person's mental state; andd. The signature of the licensed practitioner or designee; and(2) The licensed practitioner or designee shall perform such mental examination in accordance with their standard of practice pursuant to RSA 326-B, RSA 328-D or RSA 329, and any other applicable laws or rules.(g) Upon request for IEA by a petitioner, if the person sought to be admitted refuses to consent to a mental examination, a petitioner or a law enforcement officer may request a justice of the peace to order the examination as follows: (1) The request shall be in the form of a complaint and prayer for compulsory mental examination pursuant to RSA 135-C:28, II and NHJB-2826-D (03/17/2022), which shall be signed and sworn to before a justice of the peace; and(2) The complaint shall be submitted to the justice of the peace along with the petition.(h) The certifying practitioner shall not sign the certificate if: (1) The person has untreated medical ailments that may be the cause of the person's mental health concerns;(2) The person has medical ailments that cannot be safely treated by the medical services available at the DRF; or(3) The person is incapacitated from alcohol or substance use.N.H. Admin. Code § He-M 614.05
Amended by Volume XLII Number 14, Filed April 7, 2022, Proposed by #13350, EMERGENCY RULE, Effective 3/16/2022, Expires 9/12/2022 (EMERGENCY).Derived from Volume XLII Number 45, Filed November 10, 2022, Proposed by #13456, Effective 10/6/2022, Expires 10/6/2032.