Georgia DBHDD Form 1013 Certificate for Transport
Form 1013 is a certificate from the Georgia Department of Behavioral Health that authorizes the transport of individuals requiring mental health treatment. It outlines the procedures for evaluation and transportation of individuals identified as mentally ill with imminent risk. Proper completion is crucial for ensuring safety and legal compliance when transporting individuals to an emergency receiving facility.
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How do I fill this out?
In completing Form 1013, first ensure the individual meets the criteria for mental illness and imminent risk. Gather all necessary clinical information before proceeding. Finally, fill out the form accurately, ensuring all required fields are completed to authorize the individual’s transport.
How to fill out the Georgia DBHDD Form 1013 Certificate for Transport?
1
Determine if the individual meets mental illness and imminent risk criteria.
2
Contact the Emergency Receiving Facility for admission capacity.
3
Complete all sections of the Form 1013 accurately.
4
Sign and date the form with appropriate credentials.
5
Deliver the completed form to the Emergency Receiving Facility.
Who needs the Georgia DBHDD Form 1013 Certificate for Transport?
1
Healthcare professionals assessing individuals for mental health crises.
2
Mental health facilities requiring documentation for patient transports.
3
Law enforcement officers involved in transporting individuals for treatment.
4
Family members seeking to authorize transport for a loved one in crisis.
5
Social workers coordinating care for clients requiring immediate mental health attention.
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What are the instructions for submitting this form?
To submit Form 1013, completed forms should be sent to the appropriate emergency receiving facility as determined during the pre-transport evaluation. This can typically be done via email or fax directly to the facility. Always confirm the submission method with the receiving facility and ensure a copy of the form is retained for your records.
What are the important dates for this form in 2024 and 2025?
The effective date of Form 1013 is March 31, 2012. It is advisable to stay updated on any changes in form requirements or procedures imposed by the Georgia Department of Behavioral Health and Developmental Disabilities. Regularly check for any revisions or updates to ensure compliance in 2024 and 2025.
What is the purpose of this form?
The purpose of Form 1013 is to authorize the transport of individuals identified as mentally ill who may pose a risk to themselves or others. It ensures that legal and clinical criteria are met before transport to an emergency receiving facility. This document also helps maintain a clear record of the individual's mental health evaluation and transport details for further review and treatment.
Tell me about this form and its components and fields line-by-line.
- 1. Identification: Includes the individual's name, date, and location of examination.
- 2. Physician's Opinion: Contains the clinician's assessment regarding the individual's mental health condition.
- 3. Transport Details: Documents the specifics about the transportation procedure, including the peace officer's report.
- 4. Emergency Receiving Facility: Specifies where the individual will be taken for evaluation.
- 5. Signatories: Includes signatures of the clinicians and peace officers involved in the process.
What happens if I fail to submit this form?
Failing to submit Form 1013 can result in delays in essential mental health treatment for the individual in crisis. Furthermore, inadequate documentation may lead to legal complications for the transporting party. Ensuring timely and accurate submission is critical to safeguarding the individual's well-being and compliance with health guidelines.
- Delay in Treatment: Not submitting the form delays necessary mental health interventions.
- Legal Risks: Incomplete documentation can lead to legal challenges.
- Safety Concerns: Transporting individuals without proper forms may compromise their safety.
How do I know when to use this form?
- 1. Mental Health Crises: Utilized during evaluations of individuals in acute mental health crises.
- 2. Transport Documentation: Serves as legal documentation for transporting individuals for emergency evaluations.
- 3. Emergency Protocols: Essential for compliance with emergency mental health intervention protocols.
Frequently Asked Questions
What is Form 1013?
Form 1013 is a certificate for transporting individuals in mental health crises to emergency facilities.
Who can fill out this form?
Licensed Physicians, Psychologists, Clinical Social Workers, or Psychiatric Nurse Specialists can complete the form.
How do I fill out Form 1013?
Fill out the necessary details about the individual's mental health status and required transportation.
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Is there a time limit for completion of Form 1013?
The certificate should be completed and utilized as soon as possible but within a specified timeframe.
What happens if I miss important info on the form?
Missing information may delay the transport process or lead to legal issues; ensure all sections are filled out accurately.
How can I contact the Emergency Receiving Facility?
Contact the facility directly through the provided contact information in the form.
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