# COMAR Title 10 — Maryland Department of Health

## Subtitle 21 — Behavioral Health Regulations

### Chapter 01 — Involuntary Admission to Inpatient Mental Health Facilities

#### Regulation .03 Application for Involuntary Admission (IVA).

*COMAR 10.21.01.03*

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.