A certificate for involuntary admission of an individual under this part shall: Be based on the personal examination of the physician, psychologist, psychiatric nurse practitioner, licensed certified social worker–clinical, or licensed clinical professional counselor who signs the certificate; and Be in the form that the Secretary adopts, by rule or regulation. The rules and regulations shall require the form to include: A diagnosis of a mental disorder of the individual; An opinion that the individual needs inpatient care or treatment; and An opinion that admission to a facility or Veterans’ Administration hospital is needed for the protection of the individual or another. A certificate may not be used for admission if the examination on which the certificate is made was done: More than 1 week before the certificate is signed; or More than 30 days before the facility or the Veterans’ Administration hospital receives the application for admission. A certificate may not be used for an admission if the physician, psychologist, psychiatric nurse practitioner, licensed certified social worker–clinical, or licensed clinical professional counselor who signed the certificate: Has a financial interest, through ownership or compensation, in a proprietary facility and admission to that proprietary facility is sought for the individual whose status is being certified; or Is related, by blood or marriage, to the individual or to the applicant.