Regulation .03 Application for Involuntary Admission (IVA).

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.

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.