Pennsylvania Code

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CHAPTER 5100. MENTAL HEALTH PROCEDURES

GENERAL PROVISIONS

Sec.

5100.1.    L= egal=20 base.
5100.2.    D= efinitions.=20
5100.3.    S= tatement=20 of policy.
5100.4.    S= cope.=20
TREATMENT

5100.11.    = Adequate=20 treatment.
5100.12.    = Treatment=20 facilities.
5100.13.    = Responsibility=20 for formulation and review of treatment plan.=20
5100.14.    = Appeal.=20
5100.15.    = Contents=20 of treatment plan.
5100.16.    = Review=20 and periodic reexamination.=20
MENTAL HEALTH REVIEW OFFICER AND=20 PROCEEDINGS

5100.21.    = Proceedings.=20
5100.22.    = Consultation=20 and education.
5100.23.    = Written=20 application, petitions, statements and certifications.=20
CONFIDENTIALITY OF MENTAL HEALTH=20 RECORDS

5100.31.    = Scope=20 and policy.
5100.32.    = Nonconsensual=20 release of information.
5100.33.    = Patient=92s=20 access to records and control over release of records.=20
5100.34.    = Consensual=20 release to third parties.
5100.35.    = Release=20 to courts.
5100.36.    = Departmental=20 access to records and data collection.=20
5100.37.    = Records=20 relating to drug and alcohol abuse or dependence.=20
5100.38.    = Child=20 or patient abuse.
5100.39.    = Release=20 of records.=20
FORMS

5100.41.    = Forms.=20
PATIENT = RIGHTS

5100.51.    = Preservation=20 of rights.
5100.52.    = Statement=20 of principle.
5100.53.    = Bill of=20 rights for patients.
5100.54.    = Manual=20 of rights for persons in treatment. =
5100.55.    = Notification=20 of rights.
5100.56.    = Existing=20 regulations.=20
CONTINUITY OF = CARE

5100.61.    = Continuity=20 of care.=20
VOLUNTARY=20 TREATMENT

5100.71.    = Voluntary=20 examination and treatment.
5100.72.    = Applications.=20
5100.73.    = Explanation=20 and consent to inpatient treatment. =
5100.74.    = Notice=20 to parents regarding voluntary inpatient treatment of minors.=20
5100.75.    = Physical=20 examination and formulation of individualized treatment plan.=20
5100.76.    = Notice=20 of withdrawal.
5100.77.    = Discharge=20 from voluntary inpatient treatment. =
5100.78.    = Transfer=20 of persons in voluntary treatment.=20
INVOLUNTARY=20 TREATMENT

5100.81.    = Involuntary=20 examination and treatment.
5100.82.    = Jurisdiction=20 and venue of legal proceedings. =
5100.83.    = Generally.=20
5100.84.    = Persons=20 who may be subject to involuntary emergency examination and = treatment.=20
5100.85.    = Standards.=20
5100.86.    = Involuntary=20 emergency examination and treatment not to exceed 120 hours.=20
5100.87.    = Extended=20 involuntary emergency treatment not to exceed 20 days.=20
5100.88.    = Court-ordered=20 involuntary treatment not to exceed 90 days.=20
5100.89.    = Additional=20 periods of court-ordered involuntary treatment not to exceed 180 = days.=20
5100.90.    = Transfers=20 of persons in involuntary treatment.=20
5100.90a.    State=20 mental hospital admission of involuntarily committed = individuals=97statement of=20 policy.=20
PERSONS CHARGED WITH A CRIME OR UNDER=20 SENTENCE

5100.91.    = General.=20
5100.92.    = Voluntary=20 examination and treatment of a person charged with a crime or serving = a=20 sentence.
5100.93.    = Costs=20 of treatment.=20

Authority

   The provisions of this Chapter 5100 issued under = sections=20 107=97116 of the Mental Health Procedures Act (50 P. S.=20 =A7 =A7  7107=977116); and the Mental Health and Mental = Retardation=20 Act of 1996 (50 P. S. =A7 =A7  4101=97 4704), unless = otherwise=20 noted.

Source

   The provisions of this Chapter 5100 adopted = January 26,=20 1979, effective January 27, 1979, 9 Pa.B. 315; amended October 12, = 1979,=20 effective October 13, 1979, 9 Pa.B. 3460.

Cross References

   This chapter cited in 55 Pa. Code = =A7  1151.31=20 (relating to participation requirements); 55 Pa. Code = =A7  5300.1=20 (relating to accreditation); 55 Pa. Code =A7  5300.2 = (relating to not=20 Nationally accredited or certified); and 55 Pa. Code = =A7  5320.22=20 (relating to governing body).

GENERAL PROVISIONS

=A7 5100.1. Legal base.

The legal base for this chapter is section 112 of the Mental = Health=20 Procedures Act (50 P. S. =A7  7112), section 201 of the = Mental Health=20 and Mental Retardation Act of 1966 (50 P. S. =A7  4201), and = section=20 1021 of the Public Welfare Code (62 P. S. =A7  1021). =
=A7 5100.2. Definitions.

The following words and terms, when used in this chapter, = shall have=20 the following meanings, unless the context clearly indicates = otherwise:=20

   Act=97The Mental Health Procedures = Act (50 P.=20 S. =A7 =A7  7101=977503).=20

   Administrator=97The person appointed = to carry=20 out the duties specified in section 305 of the Mental Health and = Mental=20 Retardation Act of 1966 (50 P. S. =A7  4305).=20

   Agency=97An instrumentality of the = United=20 States, its departments and agencies, including the Veterans=92 = Administration.=20

   Approved facility=97A facility as = defined by=20 section 103 of the act (50 P. S. =A7  7103) which meets the = standards=20 of this chapter and other applicable Department regulations or obtains = an=20 exemption in writing from the Department under section 105 of the act = (50 P.=20 S. =A7  7105).

   Behavorial = consent=97A=20 demonstrated willingness by the patient to remain voluntarily in the = facility=20 based upon a general understanding of the nature of the usual = treatment,=20 possible restraints upon free activity, and daily life within the = facility. A=20 general understanding may be shown by a finding that a person in = treatment has=20 participated in scheduled activities and does not protest continued=20 participation.

   County of = residence=97The county=20 wherein the person had a legal residence prior to being admitted or = committed=20 to an approved facility for treatment. =

   Designated=20 facility=97The approved facility named by the county administrator = as a=20 provider of one or more specific services. A facility so designated, = either on=20 a general basis or on a case by case basis must be identified in the = county=20 annual plan. The administrator shall address the public=92s need to = know where=20 and how they can obtain services under the act.=20

   Director=97The administrative head of = a=20 facility, including a superintendent or his designee.=20

   Director of treatment team=97A = physician or=20 licensed clinical psychologist designated by the facility director to = assure=20 that each patient receives treatment under the act and this chapter = and that=20 the facility=92s treatment responsibility to the patient, as defined = in this=20 chapter, the Mental Health/Mental Retardation Act of 1966 and the act, = are=20 discharged. The director of the treatment team is responsible for = implementing=20 and reviewing the individualized treatment plan, for participating in = the=20 coordination of service delivery between other service providers, and = for=20 insuring that the unique skills and knowledge of each team member are=20 utilized. The director of the treatment team is responsible for = encouraging=20 the person in treatment to become increasingly involved in decisions = regarding=20 the treatment planning process.

   Expert in = the=20 field of mental health=97A mental health professional whose = training,=20 experience and demonstrated achievements clearly exceed the minimum = standards=20 required for recognition as a professional in his discipline, and = whose=20 broad-based skills and knowledge in his specific areas of specialty = are=20 recognized by the members of his profession to be at the highest = level.=20

   Health professional in mental = health=97A person=20 who by years of education, training, and experience in mental health = settings=20 has achieved professional recognition and standing as defined by their = respective discipline, including, but not limited to medicine, social = work,=20 psychology, nursing, occupational therapy, recreational therapy, and=20 vocational rehabilitation; and who has obtained if applicable, = licensure,=20 registration, or certification.

   Inpatient = treatment=97All treatment that requires full-time or part-time = residence in=20 a facility as defined in section 103 of the act (50 P. S. = =A7  7103).=20

   Involuntary emergency = examination=97The=20 physical and mental evaluation by a physician of an individual taken = to a=20 facility under section 302 of the act (50 P. S. =A7  7302).=20

   Involutary emergency treatment=97The = treatment=20 provided to an individual taken to a facility under section 302 of the = act (50=20 P. S. =A7  7302). Such treatment in the absence of the = individual=92s=20 consent, shall be limited to that treatment which is necessary to = protect the=20 life or health, or both, of the individual or to control behavior by = the=20 individual which is likely to result in physical injury to others.=20

   Least restrictive alternate=97The = least=20 restrictive placement or status available and appropriate to meet the = needs of=20 the patient and includes both restrictions on personal liberty and the = proximity of the treatment facility to the person=92s natural = environment. This=20 concept stresses the importance of helping each person in need of = services to=20 seek those services voluntarily. The degree of restriction or the = degree of=20 separation from the natural environment is dependent upon both the = severity of=20 the person=92s dysfunction and his strengths and resources to function = in that=20 environment. The range of treatment alternatives, stemming from the = patient=92s=20 natural environment, through supportive services to 24-hour = hospitalization,=20 must be considered in light of the person=92s capability of handling = daily tasks=20 and stress and the need, if any, for varying degrees of support or=20 supervision.

   Licensed clinical = psychologist=97A=20 psychologist licensed under the act of March 23, 1972 (P. L. 136, No. = 52) (63=20 P. S. =A7 =A7  1201=971215) who holds a doctoral degree = from an=20 accredited university and is duly trained and experienced in the = delivery of=20 direct preventive assessment and therapeutic intervention services to=20 individuals whose growth, adjustment, or functioning is actually = impaired or=20 is demonstrably at risk of impairment. =

   Mental=20 illness=97Those disorders listed in the applicable APA Diagnostic = and=20 Statistical Manual; provided however, that mental retardation, = alcoholism,=20 drug dependence and senility do not, in and of themselves, constitute = mental=20 illness. The presence of these conditions however, does not preclude = mental=20 illness.

   Mental Health and Mental = Retardation Act=20 of 1966=97The act of October 20, 1966 (P. L. 96, No. 3) (50 P. S.=20 =A7 =A7  4101=974704). =

   Peace=20 officer=97Any person who by virtue of his office of public = employment is=20 vested by law with a duty to maintain public order, to make arrests = for=20 offenses, whether that duty extends to all offenses or is limited to = specific=20 offenses, or any person on active State duty under section 311 of The = Military=20 Code of 1949 (51 P. S. =A7  1-311). Prison wardens and = guards shall be=20 considered peace officers for purposes of the act.=20

   Physician=97A person licensed to = practice=20 medicine or osteopathy in this Commonwealth.=20

   Preliminary evaluation=97The initial = assessment=20 or evaluation of the physical and mental condition of an individual; = it may be=20 conducted without substantiation by formal testing procedures. The = evaluation=20 includes an assessment of the person=92s specific physical, = psychological,=20 developmental, familial, educational or vocational, social, and = environmental=20 needs in order to determine the adequacy, of the person=92s logic, = judgment,=20 insight, and self control to responsibly meet his needs.=20

   Qualified mental health personnel=97A = person=20 employed in the fields of mental health care, treatment or = rehabilitation=20 whose experience, training, and supervision is commensurate with his = assigned=20 tasks and who has not yet met the criteria of his own profession for=20 recognition as a health professional. Such persons shall work in = programs=20 which are under the direction of mental health professionals.=20

   Treatment plan=97An individualized = plan of=20 treatment as defined in section 107 of the act (50 P. S. = =A7  7107),=20 which imposes the least restrictive alternative consistent with = affording the=20 person adequate and appropriate treatment for his condition.=20

   Treatment team=97An interdisciplinary = team of=20 at least three persons appointed by the facility director, composed of = mental=20 health professionals, health professionals and other persons who may = be=20 relevant to the patient=92s treatment. At least one member of the team = shall be=20 a physician. The treatment team shall formulate and review an = individualized=20 treatment plan for every person who is in treatment under the act. The = treatment team shall consult with appropriate professionals regarding = the=20 inclusion in the treatment plan of specific modalities not within the = training=20 or experience of the members of the treatment team.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.71=20 (relating to voluntary examination and treatment). =
=A7 5100.3. Statement of = policy.

(a)  The act establishes procedures for the = treatment of=20 mentally ill persons. The procedures are to be applied consistently = with the=20 principles of due process to make voluntary and involuntary treatment=20 available where the need is great and where the absence of treatment = could=20 result in serious harm to the mentally ill person or to others. The = act and=20 the Mental Health and Mental Retardation Act of 1966, set forth the=20 Commonwealth=92s policy and procedures regarding the provision of = mental health=20 services. This chapter implements and supplements the act and the = Mental=20 Health and Mental Retardation Act of 1966, and are to be read together = with=20 the applicable provisions of the act and the Mental Health and Mental=20 Retardation Act of 1966.=20
(b)  It is the policy of the Commonwealth to seek = to assure=20 that adequate treatment is available with the least restrictions = necessary to=20 meet each client=92s needs. While this policy remains a shared = responsibility=20 between State, county, and facility personnel, the accountability for=20 recommending the transfer to the least restrictive alternatives = available=20 remains a responsibility of those directing treatment. Adequate = treatment=20 provided in an individual=92s own community or as close as possible to = his own=20 home shall be preferred.=20
(c)  Persons who are mentally retarded, senile, = alcoholic=20 or drug dependent shall be afforded mental health examination or = treatment if=20 they are also diagnosed as mentally ill, or if there is a reasonable=20 probability that upon examination such diagnosis will be established.=20
(d)  Persons in treatment under the act shall be = afforded=20 necessary diagnostic or treatment procedures as defined in their = treatment=20 plan for conditions of mental retardation, senility, alcohol, or drug = abuse=20 when it is determined that the absence of such procedures will be = detrimental=20 to the progress of the person accomplishing the goals of treatment. =
=A7 5100.4. Scope.

(a)  This chapter applies to all involuntary = treatment of=20 mentally ill persons, whether inpatient or outpatient, and for all = voluntary=20 inpatient treatment of mentally ill persons.=20
(b)  Persons 70 years of age or older who have been = continuously hospitalized in a State-operated facility for at least 10 = years=20 and who are chronically disabled shall not be subject to the = procedures of the=20 act.=20
   (1)  The Department extends the = protections of=20 =A7 =A7  5100.11, 5100.13=975100.16, 5100.31=975100.39 = and=20 5100.51=975100.56 to these persons.=20
   (2)  The Department may continue to = provide all=20 necessary treatment to such persons regardless of their ability to = freely give=20 rational informed consent except when such a person protests treatment = or=20 residence at a State operated facility.=20
   (3)  Persons described in this = subsection may=20 become subject to involuntary treatment when the person protests and = criteria=20 for involuntary treatment are met. =

TREATMENT

=A7 5100.11. Adequate = treatment.

(a)  Adequate treatment provided by an approved = facility=20 shall be designed on an individual basis under the relevant statutes,=20 regulations, and professional standards to promote the recovery from = mental=20 illness.=20
(b)  Treatment provided on an inpatient, outpatient = or=20 partial hospitalization basis shall reflect the needs of the = individual both=20 independently and in light of the community resources, family or = friends=20 available to lend support and assistance to the person while in = treatment.=20 These resources shall be considered in determining the adequacy of the = least=20 restrictive setting appropriate to his treatment.=20
(c)  The adequacy of an individual=92s treatment = may also be=20 reviewed through mechanisms of peer review and utilization review.=20
(d)  Involuntary treatment, voluntary outpatient = treatment=20 funded at least in part with public moneys or voluntary inpatient = treatment is=20 not adequate treatment unless it is provided in or at an approved = facility or=20 by an agency of the United States.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); and 55 Pa. Code =A7  5320.22 (relating = to=20 governing body).
=A7 5100.12. Treatment = facilities.

(a)  The Department, through the Deputy Secretary = of Mental=20 Health, will approve facilities under section 105 of the act (50 P. S. = =A7  7105). Designation of appropriate approved facilities = within the=20 county shall be made by the county administrator for those patients = using=20 mental health/mental retardation (MH/MR) funds. All other patients may = use any=20 approved facility.=20
(b)  All mental health facilities providing or = planning to=20 provide involuntary treatment or voluntary treatment shall be approved = annually by the Department by application to the Deputy Secretary of = Mental=20 Health.=20
(c)  Inpatient facilities treating persons who are = either=20 enrolled in or who are about to be enrolled in a county mental health = program=20 shall notify the appropriate administrator of the proposed discharge = plan as=20 early as possible. The facility shall encourage interagency = cooperation in=20 developing predischarge planning.=20
(d)  Chapters 4210 and 5300 (relating to = description of=20 services and service areas; and private psychiatric hospital) shall be = interpreted consistently with this chapter.=20
(e)  Facilities requesting an exemption from = approval=20 standards shall submit a written request to the Deputy Secretary of = Mental=20 Health. Each request shall state the compelling reasons why an = exemption=20 should be granted and the duration of such exemption.=20
(f)  The administrator shall publicly designate = which=20 approved facilities are available to provide involuntary emergency=20 examinations, involuntary treatment or voluntary treatment funded in = whole or=20 in part by MH/MR funds.
=A7 5100.13. Responsibility for = formulation=20 and review of treatment plan.

(a)  The director of the treatment team shall = assure that=20 staff trained and experienced in the use of the modalities proposed in = the=20 treatment plan participate in its development, implementation and = review.=20
(b)  The director of the treatment team shall be=20 responsible for:=20
   (1)  Insuring that the person in = treatment is=20 encouraged to become increasingly involved in the treatment planning = process.=20
   (2)  Implementing and reviewing the=20 individualized treatment plan and participating in the coordination of = service=20 delivery with other service providers.=20
   (3)  Insuring that the unique skills = and=20 knowledge of each team member are utilized and that specialty = consultants are=20 utilized when needed.=20
(c)  Although a treatment team must be under the = direction=20 of either a physician or a licensed clinical psychologist, specific = treatment=20 modalities may be under the direction of other mental health = professionals=20 when they are specifically trained to administer or direct such=20 modalities.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); and 55 Pa. Code =A7  5320.22 (relating = to=20 governing body).
=A7 5100.14. Appeal.

(a)  Each facility shall have a clearly defined = appeal=20 system through which any patient who wishes to voice objections = concerning his=20 treatment shall be heard and have objections determined.=20
(b)  Each facility shall monitor the appeal system = to see=20 that it works properly and records shall be maintained for review for=20 certification and licensure and for Departmental review in order to=20 investigate any complaint.=20
(c)  All patients shall be advised of such system = and be=20 encouraged to use it when they believe their treatment plan is not = necessary=20 or appropriate to their needs.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope).
=A7 5100.15. Contents of = treatment plan.

(a)  A comprehensive individualized plan of = treatment=20 shall:=20
   (1)  Be formulated to the extent = feasible, with=20 the consultation of the patient. When appropriate to the patient=92s = age, or=20 with the patient=92s consent, his family, personal guardian, or = appropriate=20 other persons should be consulted about the plan.=20
   (2)  Be based upon diagnostic = evaluation which=20 includes examination of the medical, psychological, social, cultural,=20 behavorial, familial, educational, vocational, and developmental = aspects of=20 the patient=92s situation.=20
   (3)  Set forth treatment objectives and = prescribe an integrated program of therapies, activities, experiences, = and=20 appropriate education designed to meet these objectives.=20
   (4)  Result from the collaborative=20 recommendation of the patient=92s interdisciplinary treatment team.=20
   (5)  Be maintained and updated with = progress=20 notes, and be retained in the patient=92s medical record on a form = developed by=20 the facility and approved by the Deputy Secretary of Mental Health, as = part of=20 the licensing approval process.=20
(b)  The treatment plan shall indicate what less=20 restrictive alternatives were considered and why they were not = utilized. If=20 the plan provides for restraints, the basis for the necessity for such = restraints must be stated in the plan under Chapter 13 (relating to = use of=20 restraints in treating patients/residents).=20
(c)  Individual treatment plans shall be written in = terms=20 easily explainable to the lay person and a copy of the current = treatment plan=20 shall be available for review by the person in treatment.=20
(d)  When the most appropriate form of treatment = for the=20 individual is not available or is too expensive to be feasible, that = fact=20 shall be noted on the treatment plan form.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); and 55 Pa. Code =A7  5100.75 (relating = to=20 physical examination and formulation of individualized treatment = plan).
=A7 5100.16. Review and periodic=20 reexamination.

(a)  At least once every 30 days, every person in = treatment=20 under the act shall have his treatment plan reviewed. This review = shall be=20 based upon section 108(a) of the act (50 P. S. = =A7  7108(a)). A report=20 of the review and findings shall be summarized in the patient=92s = clinical=20 record.=20
(b)  The decisions and redisposition required by = section=20 108(b) of the act, based upon such reexamination and review, shall be = recorded=20 in the patient=92s clinical record as either a progress note or in any = other=20 appropriate form acceptable to the agency=92s records committee.=20
(c)  Such record shall include information required = by=20 section 108(c) of the act.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); and 55 Pa. Code =A7  5320.52 (relating = to review=20 and periodic reexamination).

MENTAL HEALTH REVIEW OFFICER AND = PROCEEDINGS

=A7 5100.21. Proceedings.

(a)  The county administrator shall inform the = Deputy=20 Secretary of Mental Health of the appointment of mental health review=20 officers. If no review officer is appointed, then the administrator = should=20 inform the Department of the judge who hears and determines = commitments under=20 the act. The Department will inform the mental health review officers = and=20 courts of new policies, procedures, and interpretations relating to = the act=20 and the provision of mental health services and will make available = training=20 to aid them in carrying out their duties.=20
(b)  A mental health review officer, unless = specifically=20 authorized by the court having jurisdiction over the person, shall not = reduce=20 the conditions of security of a person committed under section 401 of = the act=20 (50 P. S. =A7  7401).=20
(c)  The administrator=92s office shall assist = petitioners=20 with the preparation of the commitment petitions, applications, and = request=20 for certification for persons not already subject to involuntary = treatment.=20
(d)  The administrator shall designate = representatives to=20 issue warrants for involuntary emergency commitments.=20
(e)  The administrator shall coordinate, when = designated by=20 the court, all hearings and file all applications and certifications = under the=20 act.=20
(f)  Notwithstanding any other provision of the = act, no=20 judge or mental health review officer shall specify to the treatment = team the=20 adoption of any treatment technique, modality, or drug therapy. =
=A7 5100.22. Consultation and = education.

The administrator shall, in discharging his duties under the = Mental=20 Health and Mental Retardation Act of 1966, provide the court or mental = health=20 review officer with:=20
   (1)  Education and training regarding=20 principles and practices of mental health services.=20
   (2)  Administrative consultation = regarding the=20 nature and availability of approved and designated mental health = facilities=20 and services.=20
   (3)  Case consultation if so ordered by = the=20 court or mental health review officer. =
=A7 5100.23. Written application, = petitions,=20 statements and certifications.

(a)  Written application, petitions, statements and = certifications required under this chapter shall be made upon forms = issued or=20 approved by the Department.=20
(b)  The forms listed in =A7  5100.41 = (relating to=20 forms) have been issued by the Department, and their use is mandated. = No=20 substitute for such forms is permitted without prior written = authorization of=20 the Deputy Secretary of Mental Health.=20
(c)  Other forms required under this chapter may be = developed by the administrator or the facility, but are subject to the = approval of the Department.=20
(d)  Unsworn falsification=97all statements written = under all=20 applications, petitions and certifications required under the act on=20 Departmentally issued or approved forms MH 781, 783, 784, 785, 786 and = 787,=20 shall contain the following notice=97old forms may be utilized until = the supply=20 is exhausted:=20
  ANY PERSON WHO KNOWINGLY PROVIDES ANY FALSE INFORMATION = WHEN=20 COMPLETING THIS FORM MAY BE SUBJECT TO PROSECUTION.=20
(e)  When a person is admitted for voluntary = treatment and=20 only when no part of his treatment is provided with public funds, the = new=20 voluntary admission Form MH-788 may be used. This form will be = identical to=20 Form MH-781 with the exception that the notice concerning the penalty = for=20 giving false information will be deleted. Until form MH-788 is printed = and=20 distributed, existing Form MH-781 may be utilized for this group of = persons.=20 Each facility may make the necessary deletion on Form MH-781 to = conform with=20 section 110(c) of the act (50 P. S. =A7  7110(c)).=20
(f)  Submission to county administrator:=20
   (1)  Except as set forth in paragraphs = (2)=97(5),=20 Forms MH 781, 783, 784, 785, 786 and 787, shall be provided to the=20 administrator under section 110 of the act (50 P. S. = =A7  7110).=20
   (2)  No Form MH-788 need be provided to = the=20 administrator on behalf of a patient admitted for voluntary treatment = when=20 reimbursement for treatment provided the patient will not include = public=20 monies. This shall not affect in any way the applicability to such = patients of=20 the rights and procedures afforded voluntary patients by the act and = this=20 chapter. For admission to a State facility forms must be provided to = the=20 administrator.=20
   (3)  The administrator shall review all = applications, petitions, statements and certifications provided to the = administrator=92s office to determine whether the services needed are = available=20 and to assure a continuity of care.=20
   (4)  The administrator may designate a = place=20 other than his office for filing of the forms mentioned in this = section.=20
   (5)  Mental health facilities shall = file such=20 statistical reports of activities and services required by the act and = the=20 Mental Health and Mental Retardation Act of 1966 as the Department = from time=20 to time may require, so long as the data does not identify individual=20 patients.

CONFIDENTIALITY OF MENTAL HEALTH RECORDS

=A7 5100.31. Scope and = policy.

(a)  This chapter applies to records of persons = seeking,=20 receiving or having received mental health services from any facility = as=20 defined in section 103 of the act (50 P. S. =A7  7103).=20
(b)  Persons seeking or receiving services from a = mental=20 health facility are entitled to do so with the expectation that = information=20 about them will be treated with respect and confidentiality by those = providing=20 services. Confidentiality between providers of services and their = clients is=20 necessary to develop the trust and confidence important for = therapeutic=20 intervention. While full confidentiality cannot be guaranteed to = everyone as a=20 result of Federal and State statutes which require disclosure of = information=20 for specific purposes, it remains incumbent upon service providers to = inform=20 each current client/patient of the specific limits upon = confidentiality which=20 affect his treatment when these limits become applicable. When = facilities are=20 required by Federal or State statutes or by order of a court to = release=20 information regarding a discharged patient, a good faith effort shall = be made=20 to notify the person by certified mail to the last known address.=20
(c)  As used in this chapter, =91=91records=92=92 = includes, but is=20 not limited to, all written clinical information, observations and = reports or=20 fiscal documents, relating to a prospective, present or past, client = or=20 patient, which are required or authorized to be prepared by the act or = by the=20 Mental Health and Mental Retardation Act of 1966. This includes any = central=20 file of client/patient records and reports which are required to be = maintained=20 by the Department=92s regulations or other statutes and regulations = regarding=20 service content for mental health programs. Every therapist who = reports=20 objective findings must carefully consider the impact of placing in = the=20 records statements made privately in therapy sessions.=20
(d)  Nothing in this chapter shall limit the = facility=92s=20 obligation to attempt to obtain social history and other records = necessary to=20 properly treat an involuntarily committed patient, or to obtain = information on=20 financial resources or insurance coverage necessary to determine the = liability=20 for services rendered.=20
(e)  This section applies to all records regarding = present=20 or former patients of mental health facilities, including records = relating to=20 services provided under previous mental health acts.=20
(f)  Records of a person receiving mental health = services=20 are the property of the hospital or facility in which the person is or = has=20 received services. The person who is or was receiving services shall = exercise=20 control over the release of information contained in his record except = as=20 limited by =A7  5100.32 (relating to nonconsensual release = of=20 information), and be provided with access to the records except to the = limitations under =A7  5100.33 (relating to patient=92s = access to=20 records and control over release of records).=20
(g)  The presence or absence of a person currently=20 involuntarily committed at a mental health facility is not to be = considered a=20 record within the meaning of subsection (c) and such information may = be=20 released at the discretion of the director of a facility in response = to=20 legitimate inquiries from governmental agencies or when it is clearly = in the=20 patient=92s best interest to do so.=20
(h)  No document which was a public record prior to = the=20 person=92s treatment shall become confidential by its inclusion in the = facility=92s records.=20
(i)  When information and observations regarding = clients or=20 patients are not made part of a record, there remains a duty and = obligation=20 for staff to respect the patient=92s privacy and confidentiality by = acting=20 ethically and responsibly in using or discussing such information.

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.33 (relating to = patient=92s=20 access to records and control over release of records); 55 Pa. Code=20 =A7  5200.47 (relating to other applicable regulations); 55 = Pa. Code=20 =A7  5210.26 (relating to records); 55 Pa. Code = =A7  5210.56=20 (relating to other applicable regulations); 55 Pa. Code = =A7  5221.52=20 (relating to notice of confidentiality and nondiscrimination); and 55 = Pa. Code=20 =A7  5320.26 (relating to confidentiality). =
=A7 5100.32. Nonconsensual = release of=20 information.

(a)  Records concerning persons receiving or having = received treatment shall be kept confidential and shall not be = released nor=20 their content disclosed without the consent of a person given under=20 =A7  5100.34 (relating to consensual release to third = parties), except=20 that relevant portions or summaries may be released or copied as = follows:=20
   (1)  To those actively engaged in = treating the=20 individual, or to persons at other facilities, including professional=20 treatment staff of State Correctional Institutions and county prisons, = when=20 the person is being referred to that facility and a summary or portion = of the=20 record is necessary to provide for continuity of proper care and = treatment.=20
   (2)  To third party payors, both those = operated=20 and financed in whole or in part by any governmental agency and their = agents=20 or intermediaries, or those who are identified as payor or copayor for = services and who require information to verify that services were = actually=20 provided. Information to be released without consent or court order = under this=20 subsection is limited to the staff names, the dates, types and costs = of=20 therapies or services, and a short description of the general purpose = of each=20 treatment session or service.=20
   (3)  To reviewers and inspectors, = including the=20 Joint Commission on the Accreditation of Hospitals (JCAH) and = Commonwealth=20 licensure or certification, when necessary to obtain certification as = an=20 eligible provider of services.=20
   (4)  To those participating in PSRO or=20 Utilization Reviews.=20
   (5)  To the administrator, under his = duties=20 under applicable statutes and regulations.=20
   (6)  To a court or mental health review = officer, in the course of legal proceedings authorized by the act or = this=20 chapter.=20
   (7)  In response to a court order, when = production of the documents is ordered by a court under=20 =A7  5100.35(b) (relating to release to courts).=20
   (8)  To appropriate Departmental = personnel=20 =A7  5100.38 (relating to child or patient abuse).=20
   (9)  In response to an emergency = medical=20 situation when release of information is necessary to prevent serious = risk of=20 bodily harm or death. Only specific information pertinent to the = relief of the=20 emergency may be released on a nonconsensual basis.=20
   (10)  To parents or guardians and = others when=20 necessary to obtain consent to medical treatment.=20
   (11)  To attorneys assigned to = represent the=20 subject of a commitment hearing.=20
(b)  Current patients or clients or the parents of = patients=20 under the age of 14 shall be notified of the specific conditions under = which=20 information may be released without their consent.=20
(c)  Information made available under this section = shall be=20 limited to that information relevant and necessary to the purpose for = which=20 the information is sought. The information may not, without the = patient=92s=20 consent, be released to additional persons or entities, or used for = additional=20 purposes. Requests for information and the action taken should be = recorded in=20 the patient=92s records.

Notes of Decisions

   Duty to Report=20
   Mental healthcare workers do not have an = affirmative duty=20 to investigate and report possible crimes involving their patients.=20 Hennessy v. Santiago, 708 A.2d 1269 (Pa. Super. 1998).=20
   Release of Information in Response to Medical=20 Emergency=20
   Regulations which provide for the nonconsensual = release=20 of confidential information when release is necessary to prevent harm = or death=20 in response to medical emergency may include situations wherein a = psychiatric=20 patient=92s threats to harm a third party are disclosed. Ms. B. v. = Montgomery=20 County Emergency Service, 799 F.Supp. 534 (E.D. Pa. 1992), = affirmed, 989=20 F.2d 488 (3d Cir. Pa. 1993); cert. denied, 510 U. S. 860, 126 L. Ed. = 2d 133,=20 114 S. Ct. 174 (1993).

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.31 (relating to = scope and=20 policy); 55 Pa. Code =A7  5100.34 (relating to consensual = release to=20 third parties); 55 Pa. Code =A7  5100.90a (relating to State = mental=20 hospital admission of involuntarily committed individuals=97statement = of=20 policy); 55 Pa. Code =A7  5200.41 (relating to records); 55 = Pa. Code=20 =A7  5200.47 (relating to other applicable regulations); 55 = Pa. Code=20 =A7  5210.26 (relating to records); 55 Pa. Code = =A7  5210.56=20 (relating to other applicable regulations); 55 Pa. Code = =A7  5221.52=20 (relating to notice of confidentiality and nondiscrimination); and 55 = Pa. Code=20 =A7  5320.26 (relating to confidentiality). =
=A7 5100.33. Patient=92s access = to records and=20 control over release of records.

(a)  When a client/patient, 14 years of age or = older,=20 understands the nature of documents to be released and the purpose of=20 releasing them, he shall control release of his records. For a client = who=20 lacks this understanding, any person chosen by the patient may = exercise this=20 right if found by the director to be acting in the patient=92s best = interest. In=20 the event that the client/patient is deceased, control over release of = records=20 may be exercised by the client=92s/patient=92s chosen executor, = administrator or=20 other personal representative of his estate, or, if there is no chosen = personal representative, by a person otherwise empowered by court = order to=20 exercise control over the records. In the event that the = client/patient is=20 less than 14 years of age or has been adjudicated legally incompetent, = control=20 over release of the client=92s/patient=92s records may be exercised by = a parent or=20 guardian of the client/patient respectively.=20
(b)  The term =91=91access=92=92 when used in this = section refers=20 to physical examination of the record, but does not include nor imply = physical=20 possession of the records themselves or a copy thereof except as = provided in=20 this chapter.=20
(c)  A person who has received or is receiving = treatment=20 may request access to his record, and shall be denied such access to = limited=20 portions of the record only:=20
   (1)  Upon documentation by the = treatment team=20 leader, it is determined by the director that disclosure of specific=20 information concerning treatment will constitute a substantial = detriment to=20 the patient=92s treatment.=20
   (2)  When disclosure of specific = information=20 will reveal the identity of persons or breach the trust or = confidentiality of=20 persons who have provided information upon an agreement to maintain = their=20 confidentiality.=20
(d)  A patient may obtain access to his records = through the=20 facility, or in the case of those records kept by the county = administrator,=20 through the physician or mental health professional designated by the=20 administrator. Any third parties who are granted access to records may = discuss=20 this information with the patient only insofar as necessary to = represent the=20 patient in legal proceedings or other matters for which records have = been=20 released. Discussion of records with patients should be part of the=20 therapeutic process and is not to be undertaken by other than mental = health=20 professionals.=20
(e)  The limitations in subsection (c) are = applicable to=20 parents, guardians, and others who may control access over records as=20 described in subsection (a) except that the possibility of substantial = detriment to the parent, guardian, or other person may also be = considered.=20
(f)  If a person wishes to enter a written reaction = qualifying or rebutting information in their records which they = believe to be=20 erroneous or misleading, they shall have the right to prepare such = statement=20 for inclusion as part of their record. The patient=92s written = reaction shall=20 accompany all released records.=20
(g)  The director of the treatment team or the = facility=20 director may require that a mental health professional, who is a = member of the=20 treatment team, and who has reviewed the record in advance, be present = when=20 the patient or other person examines the record to aid in the = interpretation=20 of documents in the record. If the records pertain to a former = patient, an=20 appropriate mental health professional may be designated by the = facility=20 director.=20
(h)  Access to presentence reports, which may be = part of=20 the persons=92 records, is governed Pa.R.Crim.P. No. 1404 (relating to = disclosure of reports), and the patient may have access to these = records only=20 upon order of the sentencing judge. Any conditions of confidentiality = imposed=20 by the sentencing judge must be complied with. Similarily, parole and=20 probation reports shall be released or access to them given only in = accordance=20 with 37 Pa. Code Part II (relating to Board of Probation and Parole).=20
(i)  If a person is denied access to all or part of = his=20 record, this fact and the basis for the denial shall be noted in the = person=92s=20 record.=20
(j)  When records or information have been = forwarded from=20 one agency to another agency, the receiving agency may not refuse the = client=20 or patient access to the records received except in accordance with = subsection=20 (c). Records received from other agencies become part of the = client/patient=92s=20 active record and are subject to the controls exercised over them by = the=20 client, patient, or those with authority over records as defined in=20 =A7  5100.31 (relating to scope and policy).

Notes of Decisions

   Patient access to whatever record was made of = commitment=20 hearing, in the form it exists, is a minimal requirement to comport = with=20 procedural due process. In re S.O., 492 A.2d 727 (Pa. Super. = 1985).

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.31 (relating to = scope and=20 policy); 55 Pa. Code =A7  5100.34 (relating to consensual = release to=20 third parties); 55 Pa. Code =A7  5200.41 (relating to = records); 55 Pa.=20 Code =A7  5200.47 (relating to other applicable = regulations); 55 Pa.=20 Code =A7  5210.26 (relating to records); 55 Pa. Code=20 =A7  5210.56 (relating to other applicable regulations); 55 = Pa. Code=20 =A7  5221.52 (relating to notice of confidentiality and=20 nondiscrimination); and 55 Pa. Code =A7  5320.26 (relating = to=20 confidentiality).
=A7 5100.34. Consensual release = to third=20 parties.

(a)  Access to records, as defined in=20 =A7  5100.33(b) (relating to patient=92s access to records = and control=20 over release of records) will be granted to persons other than the = patient=20 upon written consent of the client/patient. With the consent, copies = of=20 excerpts or a summary of a record may be provided to specific persons = at the=20 discretion of the director. If copies of excerpts or summaries are = provided, a=20 charge may be made against the patient or person receiving the record = for the=20 cost of making the copies. The facility may require payment for the = copies in=20 advance.=20
(b)  When a patient designates a third party as = either a=20 payor or copayor for mental health services, this designation carries = with it=20 his consent to release information to representatives of that payor = which is=20 necessary to establish reimbursement eligibility. Unless otherwise = consented=20 to by the patient, information released to the third-party payors = shall be=20 limited to that necessary to establish the claims for which = reimbursement is=20 sought.=20
(c)  Clients, patients, or other persons consenting = to=20 release of records are to be informed of their right, subject to=20 =A7  5100.33 to inspect material to be released.=20
(d)  When records are released or disclosed under=20 =A7  5100.32 (relating to nonconsenual release of = information) or=20 subsections (a) and (b) the written or oral disclosure shall be = accompanied by=20 a written statement which reads as follows:=20
=91=91This information has been disclosed to you from records = whose=20 confidentiality is protected by State statute. State regulations limit = your=20 right to make any further disclosure of this information without prior = written=20 consent of the person to whom it pertains.=92=92=20
(e)  The limitation in subsection (d) does not = prohibit the=20 re-release of information in accordance with =A7  5100.32.=20
(f)  Each facility shall prepare a form for use in = the=20 voluntary release of records which shall meet the following = requirements:=20
   (1)  A time limit on its validity which = shows=20 starting and ending dates.=20
   (2)  Identification of the agency or = person to=20 whom the records are to be released.=20
   (3)  A statement of the specific = purposes for=20 which the released records are to be used.=20
   (4)  A statement identifying the = specific=20 relevant and timely information to be released.=20
   (5)  A place for the signature of the=20 client/patient or parent or guardian and the date, following a = statement that=20 the person understands the nature of his release.=20
   (6)  A place for the signature of a = staff=20 person obtaining the consent of the client/patient or parent or = guardian and=20 the date.=20
   (7)  A place to record a verbal consent = to=20 release of information given by a person physically unable to provide = a=20 signature and a place for the signatures of two responsible persons = who=20 witnessed that the person understood the nature of the release and = freely gave=20 his verbal consent.=20
   (8)  Indication that the consent is = revocable=20 at the written request of the person giving consent, or oral request = as in=20 paragraph (7).=20
(g)  A mental health facility receiving a request = for=20 information from a governmental agency may accept that agency=92s = release of=20 information form if signed by the patient/client or the person legally = responsible for the control of information unless the patient has = specifically=20 expressed opposition to that agency receiving information.

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.32 (relating to=20 nonconsensual release of information); 55 Pa. Code = =A7  5200.41=20 (relating to records); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.26 (relating = to=20 records); 55 Pa. Code =A7  5210.56 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5221.52 (relating to notice = of=20 confidentiality and nondiscrimination); and 55 Pa. Code = =A7  5320.26=20 (relating to confidentiality).
=A7 5100.35. Release to = courts.

(a)  Each facility director shall designate one or = more=20 persons as a records officer, who shall maintain the confidentiality = of=20 client/patient records in accordance with this chapter.=20
(b)  Records shall comply with the following:=20
   (1)  Whenever a client/patient=92s = records are=20 subpoenaed or otherwise made subject to discovery proceedings in a = court=20 proceeding, other than proceedings authorized by the act, and the=20 patient/client has not consented or does not consent to release of the = records, no records should be released in the absence of an additional = order=20 of court.=20
   (2)  The records officer, or his = designee, is=20 to inform the court either in writing or in person that, under statute = and=20 regulations, the records are confidential and cannot be released = without an=20 order of the court. Neither the records officer nor the facility = director has=20 any further duty to oppose a subpoena beyond stating to the the court = that the=20 records are confidential and cannot be released without an order of = the court;=20 however, nothing in this section shall be construed as authorizing = such a=20 court order.=20
   (3)  If it is known that a patient has = a=20 current attorney of record for the given proceedings, that attorney = shall be=20 informed of the request of subpoena, if not already served with a = copy, and=20 shall be expected to represent and protect the client/patient=92s = interests in=20 the confidentiality of the records. The person whose record has been=20 subpoenaed shall be notified of such action if they are currently = receiving=20 services and their whereabouts are known, unless served with a copy of = the=20 subpoena. Those currently in treatment shall also be advised that they = may=20 wish to obtain an attorney to represent their interests. In the case = of=20 persons no longer receiving services, the facility shall send this=20 notification by certified mail to the last known address.=20
(c)  If a present or former patient sues a person = or=20 organization providing services subject to the act in connection with = said=20 patient=92s care, custody, evaluation or treatment, or in connection = with an=20 incident related thereto, defense counsel for said service provider = shall have=20 such access to the present or former patient=92s records as such = counsel deems=20 necessary in preparing a defense. Counsel receiving such records shall = maintain their confidentiality and shall limit the disclosure of the = contents=20 thereof to those items they deem necessary to allow counsel to prepare = and=20 present a proper defense.=20
(d)  All employes of a facility shall be informed = of the=20 rules and regulations regarding confidentiality of records and shall = also be=20 informed that violation of them could potentially subject them to = civil or=20 criminal liability. Training for employes regarding confidentiality = remains=20 the responsibility of the facility director.

Notes of Decisions

   Release Appropriate=20
   Information in defendant=92s treatment records = which had=20 been the subject of earlier newspaper articles and had been discussed = without=20 objection in deposition was a rational and admissible source for the = jury to=20 consider in determining the harm caused to plaintiff=92s reputation = which was=20 brought about by the emotional and mental stress under which defendant = wrote=20 articles with underlying hatred for plaintiff and plaintiff=92s = pursuit of=20 prosecution of defendant for wiretapping. It was beyond argument that=20 defendant=92s mental and emotional problems had become so familiar in = the public=20 domain that the additional notice of certain medical records had no = impact and=20 was harmless evidence in this case. Sprague v. Walter, 656 A.2d = 890=20 (Pa. Super. 1995).

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.32 (relating to=20 nonconsensual release of information); 55 Pa. Code = =A7  5200.41=20 (relating to records); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.26 (relating = to=20 records); 55 Pa. Code =A7  5210.56 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5221.52 (relating to notice = of=20 confidentiality and nondiscrimination); and 55 Pa. Code = =A7  5320.26=20 (relating to confidentiality).
=A7 5100.36. Departmental access = to records=20 and data collection.

(a)  Notwithstanding any part of this chapter to = the=20 contrary, employes of the Department shall not be denied access to any = patient=20 records where such access is necessary and appropriate for the = employe=92s=20 proper performance of his duties. The facility director shall make = such=20 decision, and shall be responsible for limiting access to those = portions which=20 are relevant to the request.=20
(b)  Any conflict as to access by an employe to = patient=20 records at State hospitals shall be resolved by the Regional = Commissioner of=20 Mental Health.=20
(c)  Collection and analysis of clinical or = statistical=20 data by the Department, the administrator, or the facility for = administrative=20 or research purposes may be undertaken as long as the report or paper = prepared=20 from the data does not identify any individual patient without his=20 consent.

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.41 (relating to = records);=20 55 Pa. Code =A7  5200.47 (relating to other applicable = regulations);=20 55 Pa. Code =A7  5210.26 (relating to records); 55 Pa. Code=20 =A7  5210.56 (relating to other applicable regulations); 55 = Pa. Code=20 =A7  5221.52 (relating to notice of confidentiality and=20 nondiscrimination); and 55 Pa. Code =A7  5320.26 (relating = to=20 confidentiality).
=A7 5100.37. Records relating to = drug and=20 alcohol abuse or dependence.

Whenever information in a patient=92s records relates to drug = or=20 alcohol abuse or dependency, as defined in 71 P. S. = =A7  1690.102,=20 those specific portions of the patient=92s records are subject to the=20 confidentiality provisions of section 8(c) of the Pennsylvania Drug = and=20 Alcohol Abuse Control Act (71 P. S. =A7  1690.108(c)), and = the=20 regulations promulgated thereunder, 4 Pa. Code =A7  255.5 = (relating to=20 projects and coordinating bodies: disclosure of client-oriented=20 information).

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.41 (relating to = records);=20 55 Pa. Code =A7  5200.47 (relating to other applicable = regulations);=20 55 Pa. Code =A7  5210.26 (relating to records); 55 Pa. Code=20 =A7  5210.56 (relating to other applicable regulations); 55 = Pa. Code=20 =A7  5221.52 (relating to notice of confidentiality and=20 nondiscrimination); and 55 Pa. Code =A7  5320.26 (relating = to=20 confidentiality).
=A7 5100.38. Child or patient = abuse.

Nothing in this chapter shall conflict with the mandatory = statutory=20 or regulatory requirements of reporting suspected or discovered child = abuse or=20 patient abuse. Whenever a conflict exists between the reporting = requirements=20 of the Child Protective Services Act (11 P. S. = =A7 =A7  2201=972224),=20 and the confidentiality of mental health records, the reporting = requirements=20 shall govern.

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.32 (relating to=20 nonconsensual release of information); 55 Pa. Code = =A7  5200.41=20 (relating to records); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.26 (relating = to=20 records); 55 Pa. Code =A7  5210.56 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5221.52 (relating to notice = of=20 confidentiality and nondiscrimination); and 55 Pa. Code = =A7  5320.26=20 (relating to confidentiality).
=A7 5100.39. Release of = records.

Under 42 Pa.C.S. =A7 =A7  8721=978725 = (relating to=20 availability of otherwise confidential information), records which are = otherwise confidential may be made available to certain investigating = bodies=20 upon order of a judge of the Commonwealth Court.

Cross References

   This section cited in 55 Pa. Code = =A7  3800.20=20 (relating to confidentiality of records); 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.41 (relating to = records);=20 55 Pa. Code =A7  5200.47 (relating to other applicable = regulations);=20 55 Pa. Code =A7  5210.26 (relating to records); 55 Pa. Code=20 =A7  5210.56 (relating to other applicable regulations); 55 = Pa. Code=20 =A7  5221.52 (relating to notice of confidentiality and=20 nondiscrimination); and 55 Pa. Code =A7  5320.26 (relating = to=20 confidentiality).

FORMS

=A7 5100.41. Forms.

(a)  Reference. All references to article or = section=20 numbers in the title of the forms issued by the Department refer to = articles=20 or section numbers of the act.=20
(b)  Forms. Forms adopted by the Department = as=20 published in prior regulations may be amended to conform with the act = by pen=20 and ink changes until new forms are available:=20
   MH 781. Consent for Voluntary Inpatient = Treatment=20 (Article II).=20
     MH 781-A. Initial Evaluation.=20
     MH 781-B. Explanation of = Voluntary=20 Admission Rights (Adult).=20
     MH 781-C. Explanation of = Voluntary=20 Admission Rights (Minor between 14 and 18 years of age).=20
     MH 781-D. Explanation of = Voluntary=20 Admission Rights (Minor under 14 years of age.=20
     MH 781-E. Notification of = Admission of=20 Child (For parents or guardians of minor 14-18 years old).=20
     MH 781-F. Request to Withdraw = from=20 Treatment.=20
     MH 781-X. Request for Voluntary=20 Admission of Person Charged with Crime or Serving Sentence.=20
     MH 781-Y. Consent for Voluntary=20 In-patient Treatment of Person Charged With Crime or Serving Sentence. =
     MH 781-Z. Explanation of = Admission of=20 Person Charged With Crime or Serving Sentence.=20
   MH 782. Patient=92s Bill of Rights.=20
   MH 783. Application for Involuntary = Emergency=20 Examination and Treatment.=20
     MH 783-A. Explanation of Rights = under=20 Emergency Involuntary Treatment.=20
     MH 783-B. Explanation of = Warrant.=20
   MH 784. Application for Extended Involuntary = Treatment (section 303).=20
     MH 784-A. Notice of Intent to = File or=20 Petition for Extended Involuntary Treatment and Explanation of Rights. =
   MH 785. Petition for Involuntary Treatment.=20
     MH 785-A. Notice of Intent to = File a=20 Petition for Extended Involuntary Treatment and Explanation of Rights. =
     MH 785-B. Notice of a Hearing on = Petition for Involuntary Treatment and Explanation of Rights.=20
   MH 786. Petition for Involuntary = Treatment=97Through=20 the Criminal Justice System.=20
     MH 786-A. Notice of Intent to = File a=20 Petition for (Extended) Involuntary Treatment at a Mental Health = Facility and=20 Explanation of Rights.=20
   MH 787. Petition for Commitment for = Involuntary=20 Treatment After Finding of Incompetence to Stand Trial Where Severe = Mental=20 Disability is Not Present.=20
   MH/MR 50. Patient Consent to Transfer.=20
(c)  Forms amended in this chapter include:=20
   MH-781-X=20
   MH-788

Cross References

   This section cited in 55 Pa. Code = =A7  5100.23=20 (relating to written application, petitions, statements and = certifications).

PATIENT RIGHTS

=A7 5100.51. Preservation of = rights.

Persons subject to treatment under this chapter shall retain = all=20 civil rights that have not been specifically curtailed by separate = judicial or=20 administrative determination by the appropriate legal authority.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.56 (relating = to other=20 applicable regulations); 55 Pa. Code =A7  5320.22 (relating = to=20 governing body); and 55 Pa. Code =A7  5320.45 (relating to = staff=20 orientation and training).
=A7 5100.52. Statement of = principle.

(a)  Facilities. Upon voluntary or = involuntary=20 admission to an inpatient facility, each patient shall be given a copy = of the=20 summary statement of the Bill of Rights, contained in = =A7  5100.53=20 (relating to bill of rights for patients), Form MH-782, or the patient = rights=20 pamphlet (PWPE # 605), published by the Department entitled You = Have a=20 Right to be Treated with Dignity and Respect. Appended to each of = these=20 documents shall be the names, addresses, and telephone numbers of = legal and=20 other available advocacy services. Assistance in contacting a legal or = other=20 advocate shall be provided by the facility to each patient upon = request. The=20 rights contained therein shall be explained to the extent feasible to = persons=20 who cannot read or understand them. Within 72 hours of admission, the = Manual=20 of Rights, set forth in =A7  5100.54 (relating to manual of = rights for=20 persons in treatment), or the Patient Rights Handbook (PWPE # 606), = entitled=20 Your Rights Are Assured, shall be made available or given to = each=20 patient, and the rights contained therein shall be explained to the = extent=20 feasible to persons who cannot read or understand them. Additionally, = a copy=20 of either the Manual of Rights or the Patient Rights Handbook (PWPE # = 606)=20 entitled Your Rights Are Assured, shall be made available for = each=20 patient access in each patient living area.=20
(b)  Current patients. All current patients = shall be=20 given a copy of either the Manual of Rights, or Patient Rights = Handbook=20 entitled Your Rights Are Assured (PWPE # 606), as in subsection = (a).=20 Existing supplies of previously printed forms and manuals may be = utilized.=20
(c)  Manual of rights. Upon request, a = complete copy=20 of the Manual of Rights shall be made available to the family, = guardian,=20 attorney, and other interested parties.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.56 (relating = to other=20 applicable regulations); 55 Pa. Code =A7  5320.22 (relating = to=20 governing body); 55 Pa. Code =A7  5320.33 (relating to=20 resident/provider contract; information on resident rights); and 55 = Pa. Code=20 =A7  5320.45 (relating to staff orientation and training). =
=A7 5100.53. Bill of rights for=20 patients.

The following is the bill of rights for patients:

BILL OF RIGHTS

YOU HAVE A RIGHT TO BE TREATED WITH DIGNITY=20 AND
RESPECT

YOU SHALL RETAIN ALL CIVIL RIGHTS THAT HAVE NOT = BEEN
SPECIFICALLY=20 CURTAILED BY ORDER OF COURT

You have the right to unrestricted and private communication = inside=20 and outside this facility including the following rights:=20
   a. To a peaceful assembly and to join with = other=20 patients to organize a body of or participate in patient government = when=20 patient government has been determined to be feasible by the facility. =
   b. To be assisted by any advocate of your = choice in=20 the assertion of your rights and to see a lawyer in private at any = time.=20
   c. To make complaints and to have your = complaints=20 heard and adjudicated promptly.=20
   d. To receive visitors of your own choice at = reasonable hours unless your treatment team has determined in advance = that a=20 visitor or visitors would seriously interfere with your or others=92 = treatment=20 or welfare.=20
   e. To receive and send unopened letters and = to have=20 outgoing letters stamped and mailed. Incoming mail may be examined for = good=20 reason in your presence for contraband. Contraband means specific = property=20 which entails a threat to your health and welfare or to the hospital=20 community.=20
   f. To have access to telephone designated = for=20 patient use.=20
2. You have the right to practice the religion of your = choice or=20 to abstain from religious practices.=20
3. You have the right to keep and to use personal = possessions,=20 unless it has been determined that specific personal property is = contraband.=20 The reasons for imposing any limitation and its scope must be clearly = defined,=20 recorded and explained to you. You have the right to sell any personal = article=20 you made and keep the proceeds from its sale.=20
4. You have the right to handle your personal affairs = including=20 making contracts, holding a driver=92s license or professional = license,=20 marrying, or obtaining a divorce and writing a will.=20
5. You have the right to participate in the development = and=20 review of your treatment plan.=20
6. You have the right to receive treatment in the least=20 restrictive setting within the facility necessary to accomplish the = treatment=20 goals.=20
7. You have the right to be discharged from the facility = as soon=20 as you no longer need care and treatment.=20
8. You have the right not to be subjected to any harsh = or=20 unusual treatment.=20
9. If you have been involuntarily committed in = accordance with=20 civil court proceedings, and you are not receiving treatment, and you = are not=20 dangerous to yourself or others, and you can survive safely in the = community,=20 you have the right to be discharged from the facility.=20
10. You have a right to be paid for any work you do = which=20 benefits the operation and maintenance of the facility in accordance = with=20 existing Federal wage and hour regulations.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.52 (relating to = statement=20 of principle); 55 Pa. Code =A7  5200.47 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5210.56 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5320.22 (relating to = governing body);=20 and 55 Pa. Code =A7  5320.45 (relating to staff orientation = and=20 training).
=A7 5100.54. Manual of rights for = persons in=20 treatment.

The following is the manual of rights for persons in = treatment:=20
Article I: The Right to Communicate

Statement of Principle

   1. Right to Information=20
   2. Right to Assistance=20
   3. Right to an Attorney=20
   4. Right to Have Visitors=20
   5. Right to Send and Receive Letters=20
   6. Right to Use Telephones=20
Article II: The Right of Religious Freedom

Statement of Principle

   1. Right to Refuse Medication=20
   2. Right to Diets Based on Religious or = Ethical=20 Consideration=20
   3. Right to Abstain from Religious Practices =
Article III: The Right to Handle Your Personal Affairs =
Article IV: The Right to a Humane Physical and = Psychological=20 Environment=20
Article V: The Right to Treatment

Statement of Principle

   1. Individualized Treatment Plan=20
   2. Discharge=20
Article VI: Permissible, Restricted and Prohibited = Treatment=20 Procedures

Statement of Principle

   1. Permissible Procedures=20
   2. Restricted Procedures=20
   3. Prohibited Procedures=20
Article VII: Grievance and Appeal Procedures

Statement of Principle

   1. Grievance Procedures=20
   2. First Level Appeal=20
   3. Second Level Appeal

ARTICLE I
THE RIGHT TO=20 COMMUNICATE

Statement = of=20 Principle.

(a)  Every patient has the right and shall be = encouraged to=20 communicate freely and privately with others within the facility and = in the=20 community at large, as described below. This is based upon the firm = belief=20 that meaningful communications are essential to a successful course of = treatment. These rights may be suspended or restricted for a limited = period by=20 the treating physician only when reasonable cause exists to believe = that=20 failure to suspend communications will result in a substantial risk of = serious=20 and immediate harm to the patient or others, or that a crime is being=20 committed. The physician shall fully explain any suspensions or = restrictions=20 of these rights to the patient and document the reasons for the = restriction in=20 the patient=92s record. Suspension or restrictions shall be reviewed = and=20 documented every 48 hours until the risk of serious and immediate harm = is=20 reduced.=20
(b)  Every patient shall have the right to make = complaints=20 and offer suggestions to the director, or his designee, regarding the=20 operation of the facility, and may meet with other patients to discuss = their=20 concerns with facility administrators. Complaints and suggestions = shall be=20 heard and decided promptly.
1. Right to Information.=20
(a)  Every patient has the right to be informed of = his=20 rights and responsibilities while in treatment, and those house rules = and=20 regulations of the facility which affect his treatment.=20
(b)  Every patient has the right to be informed of=20 diagnostic and treatment procedures, their risks and their costs, that = are=20 available to him and which would aid in his recovery from mental = illness.=20 Patients have the right to be informed of the reasons and factors = involved in=20 recommending a procedure of choice.=20
(c)  Every patient has the right to be informed of = the=20 nature of material about to be released to others (or obtained) when = he is=20 requested to sign a release of information.
2. Right to = Assistance.=20
(a)  Every patient shall have the right to the = assistance=20 of an independent person not a member of his treatment team to resolve = a=20 problem raised by the patient.=20
(b)  Each non-State facility shall designate one or = more=20 persons either on a volunteer or staff basis as needed to help = patients in=20 this manner.=20
(c)  State facilities shall designate one or more = staff to=20 aid patients, and these persons shall be accessible during regular = working=20 hours.=20
(d)  Every State facility shall advise and educate = all=20 patients about the availability and services of this program.=20
(e)  These persons will be responsible for = assisting or=20 supporting the patient in meeting with the appropriate person to = discuss the=20 problem and possible solution. They shall maintain a confidential file = of=20 requests for service and subsequent actions taken. The file shall be = open to=20 review only by the facility director or the patient=92s Attorney and = shall be=20 filed with the patient=92s clinical record upon discharge. They have = no=20 authority to directly resolve problems but may report his or her = findings=20 directly to the facility director.
3. Right to an Attorney.=20
(a)  Every patient has the right to retain an = attorney of=20 his choice to assist the patient in asserting his rights to treatment = or=20 release or to aid the patient in any other matter.=20
(b)  The facility will provide patients with = referral=20 information and other non-monetary assistance to enable patients to = implement=20 this right. The names, addresses and telephone numbers of legal = services and=20 other available advocates in this area shall be given to all patients. =
(c)  Every patient has the right to see or = telephone his=20 attorney in private at any reasonable time, regardless of visiting = hours.=20
4. Right to Have Visitors.=20
(a)  Every patient has the right to receive = visitors of his=20 own choice daily, within established visiting hours, in a setting of=20 reasonable privacy conducive to free and open conversation unless a = visitor or=20 visitors are determined to seriously interfere with a patient=92s = treatment or=20 welfare.=20
(b)  Established visiting hours shall attempt to = meet the=20 needs of individual patients and visitors, and may be waived to the = extent=20 feasible to accommodate special circumstances or the needs of = individual=20 patients.
5. Right to Send and Receive Letters.=20
(a)  Every patient has the right to send unopened = mail.=20 Reasonable amounts of such mail shall be stamped free of charge if = sufficient=20 personal funds are not available.=20
(b)  Writing materials shall be made available to = patients=20 on a daily basis and an opportunity provided for writing letters and = other=20 communications. Reasonable assistance shall be provided upon request, = if=20 feasible.=20
(c)  Incoming mail may be opened only when there is = reason=20 to suspect it contains contraband, and in the presence of the patient = unless=20 dangerous or infeasible in the light of the patient=92s condition. = Contraband is=20 specific property, the possession or use of which is illegal or = entails a=20 substantial threat to the health and welfare of the patient or the = hospital=20 community.=20
(d)  Whenever mail is opened on suspicion of = contraband, an=20 identification of the person opening the mail, a statement of the = facts=20 constituting good cause, and the results of the opening including = disposition=20 shall be noted in the patient=92s record.=20
(e)  A patient=92s mail, whether incoming or = outgoing, shall=20 not be read under any circumstances, unless at the patient=92s = request.=20
6. Right to Use Telephones.=20
(a)  Every patient has the right to make telephone = calls at=20 his own expense, at reasonable times, using telephones designated for = patient=20 or public use. The facility shall take steps to provide sufficient = telephones.=20
(b)  In cases of personal emergency, when = alternative=20 methods of communication are impractical, every patient shall have the = right=20 to make reasonable local and long distance phone calls, free of = charge. These=20 calls shall be subject to reimbursement if the patient has sufficient = funds to=20 pay for the call. The director of the facility, or his delegate, shall = determine what constitutes personal emergency.

ARTICLE II
THE RIGHT TO=20 RELIGIOUS
FREEDOM

Statement of=20 Principle.

Every patient has the right to follow and practice his = religion.=20 Substantiated ethical convictions held independently of a belief in = any=20 religion shall be accorded the same respect as religious belief. The = facilty=20 shall provide reasonable assistance to enable a patient to effect this = right.=20
The exercise of these rights may be limited only if it poses = a=20 serious threat to the freedom or welfare of others, or a serious = danger to the=20 patient.
1. Right to Refuse Medication.=20
Any patient who holds a substantiated belief in the power of=20 spiritual healing shall not be compelled to take medication, provided = the=20 patient is intellectually capable of understanding the impact of such = refusal=20 and of deciding to refuse medication.
2. Right to Diets Based = on=20 Religious Considerations.=20
The patient=92s right to independently comply with his or her = dietary=20 regimen shall not be interfered with by the facility unless unfeasible = or=20 unless there is serious danger to a person=92s health. =
3. Right to=20 Abstain from Religious Practices.=20
No patient shall be required to be pressured directly or = indirectly=20 to participate in religious practices. No patient shall be compelled = to accept=20 visitation from a clergyman or minister of any religion.

ARTICLE III
THE RIGHT TO HANDLE
YOUR PERSONAL=20 AFFAIRS

Statement of Principle.

Every patient retains all civil rights not specifically = curtailed by=20 an order of a court or other body empowered to take such action.=20
(a)  Every patient has the right to handle his = personal=20 affairs. Admission or commitment to a mental health facility does not = by=20 itself, prevent a patient from holding a driver=92s license or = professional=20 license, from marrying or obtaining a divorce, from voting or writing = a will,=20 or exercising other civil and personal rights; nor is the patient = guaranteed=20 the ability to exercise any of these rights.=20
(b)  Every patient has the right to purchase, keep, = and use=20 personal possessions. This right may be limited only when the = possession or=20 use of specific property is illegal or creates a substantial threat to = the=20 health or welfare of the patient or others. The reasons for imposing = any=20 limitations on the exercise of this right and the scope of such = limitation=20 shall be clearly explained to the patient and placed in the = patient=92s record.=20
(c)  Every patient has the right to sell or retain = any=20 product or crop he makes, or grows on facility property. Money = received from=20 these activities shall not be used to pay the costs of any patient=92s = care and=20 treatment.=20
(d)  A patient shall not be deemed incompetent to = manage=20 his own affairs solely by reason of admission or commitment to a = mental health=20 facility.=20
A court finding of incompetency may not be extended beyond = the=20 specific scope of the court order.

ARTICLE IV
RIGHT TO A HUMANE PHYSICAL
AND PSYCHOLOGICAL=20 ENVIRONMENT

Statement of Principle.

Every patient has the right to reside and be treated in a = setting=20 which preserves and promotes his physical and psychological dignity.=20
(a)  Every patient has the right to be treated = humanely and=20 with consideration by all staff members. Any grossly negligent or = intentional=20 conduct of staff which causes or may cause emotional or physical harm = to a=20 patient is a violation of this right.=20
(b)  Every patient has the right to assistance in=20 developing a physical appearance which promotes a positive self image. = This=20 includes the following:=20
   (1)  The right to keep and wear his own = clothing, unless there are reasonable grounds to believe such clothing = or=20 specific items constitute a substantial threat to the health or safety = of the=20 patient or others.=20
   (2)  Clothing provided by the facility = shall be=20 neat, clean, appropriate to the season and to the extent possible, = consistent=20 with the patient=92s personal preference. This clothing shall enable = the patient=20 to make a customary appearance within the community.=20
   (3)  The right to purchase, keep, and = use=20 customary cosmetic, hygiene, and grooming articles or services unless = there=20 are reasonable grounds to believe specific articles constitute a = substantial=20 threat to the health or safety of the patient or others.=20
   (4)  Basic customary cosmetic, hygiene, = and=20 grooming articles or services shall be provided by the facility for = patients=20 who need them but cannot afford them. Patients shall be given = reasonable=20 assistance as needed in utilizing cosmetic, hygiene, and grooming = articles and=20 services.=20
(c)  Every residential patient shall be furnished = with a=20 comfortable bed and bedding, adequate change of linen, a closet or = locker for=20 personal belongings, and a bedside cabinet. Every patient, at his or = her own=20 risk, shall be allowed to keep and display appropriate personal = belongings and=20 to add personal touches to his room or living area.=20
(d)  Every patient has the right to a nutritionally = adequate diet and every patient has the right to eat or to be fed = under=20 supervision, in the dining room or area in the relaxed atmosphere, and = to use=20 normal eating implements, unless contra-indicated by the patient=92s = conduct or=20 course of treatment.=20
(e)  Every patient has the right to bathroom = facilities=20 which provide privacy for personal hygiene and meet Departmental = standards for=20 health, safety, and cleanliness.=20
(f)  Every patient has the right to therapeutic and = daily=20 living activities held in settings that approximate noninstitutional = living.=20 Dining, recreational, vocational, and other activities shall where = possible=20 and appropriate be conducted on a basis which provides interaction = between=20 male and female patients.

ARTICLE V
RIGHT TO = TREATMENT

Statement of=20 Principle.

Every patient has the right to receive treatment designed to = aid and=20 promote his recovery from mental illness. This treatment shall, = whenever=20 possible, be in or near the patient=92s home community, and shall be = in the=20 least restrictive setting available to provide adequate treatment or = to meet=20 the conditions of security imposed by a court.
1. Individual=20 Treatment Plan.=20
(a)  Every patient has the right to an = individualized=20 treatment plan, appropriate to his needs, setting forth the = objectives, goals,=20 activities, experiences, and therapies designed to promote recovery.=20
(b)  The plan shall be developed within 72 hours of = admission or commitment. It shall be revised whenever necessary and = reviewed=20 at least every 30 days.=20
(c)  Every patient has the right to participate to = the=20 extent feasible in the development of his treatment plan. The plan = shall be=20 written in terms understandable by lay persons and shall be explained = to the=20 patient. A copy of the treatment plan shall be made available for the=20 patient=92s review.
2. Discharge.=20
Every patient has the right to be discharged as soon as care = and=20 treatment is no longer necessary. Every patient has the right to all = of the=20 available treatment modalties appropriate to his or her needs which = promote=20 recovery and discharge. Treatment shall also include the appropriate=20 post-discharge rehabilitative services available in the community. =

ARTICLE VI
PERMISSIBLE SPECIALIZED AND
PROHIBITED = TREATMENT=20 PROCEDURES

Statement of Principle.

Every patient shall only receive approved treatment = procedures in=20 accordance with Departmental regulations. This treatment shall be = described in=20 his individual treatment plan and shall be explained to the patient.=20
1. Permissible Procedures.=20
(a)  All patients may in an emergency, be required = to=20 accept the minimal sufficient diagnostic procedures and treatment = necessary to=20 alleviate the emergency.=20
(b)  Patients committed pursuant to sections 303, = 304 or=20 305 of the act (50 P. S. =A7 =A7  4303, 4304, and = 4305), may also=20 be required to accept routine medical, psychiatric, psychological, and = educational programs conforming to departmental regulations and the = patient=92s=20 individualized treatment plan.=20
(c)  Any patient committed for examination by court = may be=20 required to accept the minimal diagnostic procedures necessary to = determine=20 the patient=92s mental condition.=20
(d)  Any patient in treatment on a voluntary basis = may=20 agree to participate in any and all approved treatment methods as = described in=20 his individualized treatment plan. Any voluntary patient may also = refuse to=20 participate in any aspect of his individualized treatment plan and may = request=20 a review of the proposed treatment. Refusal to accept a reviewed and = approved=20 treatment may be cause for discharge.
2. Specialized = Procedures.=20
(a)  No patient shall be subject to the withholding = of=20 privileges, nor to any system of rewards, except as part of an = individualized=20 treatment plan.=20
(b)  Electro-convulsive or other therapy, = experimental=20 treatments involving any risk to the patient, or aversion therapy = shall not be=20 prescribed unless:=20
   (1)  The patient=92s treatment team has = documented in the patient=92s record that all reasonable and less = intensive=20 treatment modalities have been considered; that the treatment = represents the=20 most effective therapy for the patient at that time; and that the = patient has=20 been given a full explanation of the nature and duration of the = proposed=20 treatment and why the treatment team is recommending the treatment; = and that=20 the patient has been told that he or she has the right to accept or = refuse the=20 proposed treatment and that if he consents, has the right to revoke = his=20 consent for any reason at any time prior to or between treatments.=20
   (2)  The treatment was recommended by = qualified=20 staff members trained and experienced in the treatment procedure and = has been=20 approved by the facility administrator if an M.D. or, if not, by the = clinical=20 director after review by the appropriate committee.=20
   (3)  The patient has given written = informed=20 consent to the specific proposed treatment. In the alternative, oral = informed=20 consent is sufficient where that consent is witnessed by two persons = not part=20 of the patient=92s treatment team. In either case, such consent shall = be limited=20 to a specified number of maximum treatments over a specific period of = time and=20 shall be revocable at any time before or between treatments. Such = withdrawal=20 of consent may be immediately effective.=20
   (4)  If a patient=92s treatment team = determines=20 that the patient could benefit from one of those specified treatments = but also=20 believes that the patient does not have the capacity to give informed = consent=20 to the treatment, a court order shall be obtained authorizing the = recommended=20 treatment before such treatment may be administered to the patient.=20
(c)  No patient shall be subject to chemical, = physical, or=20 psychological restraints, including seclusion, other than in = accordance to the=20 Department=92s regulations applicable to State Mental Health = Facilities or, in=20 case of community facilities, the policy and procedures for seclusion = and=20 restraint approved by its medical staff and governing body. A copy of = the=20 applicable regulations shall be made available to patients upon = request.=20
(d)  No patient shall be the subject of any = research,=20 unless conducted in strict compliance with Federal regulations on the=20 protection of human subjects. Patients considered for research = approved by the=20 facility shall receive and understand a full explanation of the nature = of the=20 research, the expected benefit, and the potential risk involved. = Copies of the=20 Federal regulations shall be made available to patients involved in, = or=20 considering becoming involved in, research or their advocates. Patient = research conducted in State facilities or funded by State monies = requires=20 prior approval of the Deputy Secretary of Mental Health.=20
3. Prohibited Procedures.=20
Psychosurgery, removal of organs for the purpose of = transplantation,=20 and sterilization, shall not be performed at a State-operated mental = hospital.=20

ARTICLE VII
GRIEVANCE AND=20 APPEAL
PROCEDURES

Statement of Principle.

To insure that these rights are safeguarded and that disputes = concerning their rights and others are resolved promptly and fairly, = patients=20 must have the right to lodge grievances and appeals when informal = methods of=20 resolving disputes are unsuccessful. Each facility shall have a = grievance and=20 appeal system in effect. Every patient shall be informed of the = grievance and=20 appeal system and shall be encouraged to utilize it when informal = methods of=20 resolving complaints are unsuccessful.
1. Grievance = Procedure.=20
(a)  Any patient, or those helping him, may = initiate a=20 complaint orally or in writing, concerning the exercise of these = rights or the=20 quality of services and treatment at the facility. The complaint shall = be=20 presented as soon as possible to the treatment team leader or other=20 appropriate person.=20
(b)  Every patient shall have the right to the = assistance=20 of an independent person and witnesses in presenting his complaint.=20
(c)  The treatment team leader, administrative = supervisor,=20 or their designees receiving the complaint shall investigate the = complaint and=20 make every effort to resolve it. Based upon this investigation, a = decision=20 shall be rendered in writing as soon as possible but within 48 hours = after the=20 filing of the complaint. Complaints shall be decided by persons not = directly=20 involved in the circumstances leading to the grievance.=20
(d)  The patient shall be given a copy of the = complaint and=20 final decision and a copy shall be filed in the patient=92s record.=20
2. First Level Appeal.=20
(a)  Any patient, or those helping him, may appeal = the=20 grievance decision within 10 working days of the decision. = State-operated=20 facilities shall follow the procedures set forth in this part. = Non-State=20 operated facilities shall have in effect a fair and impartial appeal=20 procedure, which shall be reviewed by the county administrator.=20
(b)  In a State-operated facility, standing Rights = Review=20 Committee composed equally of facility staff and persons from the = community=20 not affiliated with the facility shall hear the appeal and render a = written=20 decision within 10 working days of the date of the appeal. Staff = members shall=20 be appointed by the facility director. Until such time as the = committee is in=20 effect, the appeal shall be heard by a hearing examiner appointed by = the=20 regional deputy secretary. If the grievance requires immediate action, = the=20 appeal shall be heard and decided as soon as possible.=20
(c)  The patient shall be given prompt notice of = the date=20 set for the appeal and shall be informed of his right to be = represented by=20 counsel.=20
(d)  Hearings shall be informal, without strict = adherence=20 to the rules of evidence. A sufficient record of the hearing shall be = made.=20
(e)  A copy of the decision shall be given to the = patient,=20 the facility director, and filed in the patient=92s chart. =
3. Second=20 Level Appeal.=20
(a)  Any patient in a State facility, those helping = him, or=20 the facility director, may appeal the decision of the hearing examiner = or=20 Rights Review Committee within 10 working days of the decision. The = appeal=20 must set forth the specific objections to the decision.=20
(b)  The Secretary of Public Welfare shall = establish a=20 standing Rights Appeal Committee composed equally of Department and = community=20 personnel. Within 5 working days of receipt of a second level request, = the=20 Committee shall review the decision of the Rights Review Committee and = may=20 seek any additional information it deems necessary.=20
(c)  The patient shall be given prompt notice of = the date=20 set for the appeal and shall be informed of his or her right to be = represented=20 by counsel.=20
(d)  Reviews shall be informal. A sufficient record = of the=20 hearing shall be made.=20
(e)  The Committee shall submit a recommendation to = the=20 Secretary of Public Welfare within 10 working days of its receipt of = the=20 second level appeal request. The Secretary will review the findings = and=20 recommendations by the Committee and will issue a decision.=20
(f)  Nothing in this section shall be construed as=20 precluding a patient from instituting appropriate legal = proceedings.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5100.52 (relating to = statement=20 of principle); 55 Pa. Code =A7  5200.47 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5210.56 (relating to other = applicable=20 regulations); 55 Pa. Code =A7  5320.22 (relating to = governing body);=20 and 55 Pa. Code =A7  5320.45 (relating to staff orientation = and=20 training).
=A7 5100.55. Notification of = rights.

Upon receipt of a person for treatment the facility shall = advise the=20 individual of his rights, and obtain when feasible a written = acknowledgement=20 by the person that his rights affecting their treatment were = explained. In the=20 event that conditions prevent such acknowledgement or understanding, = the=20 process of notification shall be recorded by the person designated and = confirmed by a witness.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.56 (relating = to other=20 applicable regulations); 55 Pa. Code =A7  5320.22 (relating = to=20 governing body); and 55 Pa. Code =A7  5320.45 (relating to = staff=20 orientation and training).
=A7 5100.56. Existing = regulations.

(a)  Existing regulations regarding treatment = facilities=20 and procedures continue in force to guide facilities and providers in=20 protecting the rights of persons in treatment.=20
(b)  It shall be the responsibility of the = administrator in=20 utilizing facilities to assure that procedures for affecting and = protecting=20 the rights of persons in treatment are developed and followed.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.4=20 (relating to scope); 55 Pa. Code =A7  5200.47 (relating to = other=20 applicable regulations); 55 Pa. Code =A7  5210.56 (relating = to other=20 applicable regulations); 55 Pa. Code =A7  5320.22 (relating = to=20 governing body); and 55 Pa. Code =A7  5320.45 (relating to = staff=20 orientation and training).

CONTINUITY OF CARE

=A7 5100.61. Continuity of = care.

(a)  When a person in treatment under the act moves = into or=20 out of a State-operated mental health facility, the county = administrator=20 responsible for the person=92s continuity of care shall take such = actions to=20 ensure that the person receives available services as needed. In = taking such=20 actions, the administrator shall consider the person=92s plans to = utilize=20 private resources.=20
(b)  Whenever a person is considered for discharge = from=20 treatment at a State facility, the director shall take steps to assure = that=20 the appropriate county administrator=92s office is involved in = predischarge=20 planning before the discharge. The degree of involvement by the county = may be=20 based upon the person=92s plans to utilize private resources.=20
(c)  Upon discharge, the county administrator = receiving the=20 referral shall take the necessary steps to arrange for the available = mental=20 health treatment services as defined in application statutes.=20
(d)  When a person referred for service refuses to=20 cooperate with the county administrator after discharge, such person = shall be=20 evaluated for alternative services before the case can be closed. Such = evaluations should be as clinically thorough as possible. There should = be=20 documentation of repeated efforts at reinvolving the person in = voluntary=20 treatment if treatment has been recommended and of the decisions = regarding the=20 appropriateness of commitment proceedings. =

VOLUNTARY TREATMENT

=A7 5100.71. Voluntary = examination and=20 treatment.

(a)  Persons 14 years of age or older may seek = voluntary=20 inpatient treatment if they substantially understand the nature of = such=20 treatment and the treatment setting. Parents or guardians who decide = to seek=20 voluntary inpatient treatment for persons under 14 years of age may do = so only=20 in accordance with the act and applications regulations.=20
(b)  The test of a person=92s substantial = understanding for=20 inpatient treatment is met if the person gives consent to the = information and=20 explanations outlined in section 203 of the act (50 P. S. = =A7  4203).=20
(c)  Behavorial consent, as defined in = =A7  5100.2=20 (relating to definitions) shall be sufficient consent for persons = presently=20 receiving treatment at a facility to remain at that facility and to=20 participate in treatment which is explained to him. Behavioral consent = shall=20 be documented under =A7  5100.73 (relating to explanation = and consent=20 to inpatient treatment). Behavorial consent shall not be relied upon = for=20 admission to or transfer from a facility.=20
=A7 5100.72. Applications.

(a)  Written application for voluntary inpatient = treatment=20 shall be made upon Form MH-781, issued by the Department.=20
(b)  A State-operated facility shall not accept an=20 application for voluntary inpatient treatment for persons not = currently in the=20 facility unless:=20
   (1)  There is concurrence on an = individual case=20 basis given by the administrator.=20
   (2)  There is a preexisting agreement = of waiver=20 approved by the Deputy Secretary of Mental Health between the State = facility=20 and the Administrator which designates that facility as the only = provider of=20 inpatient services of the county program.=20
   (3)  There is a preexisting letter of = agreement=20 approved by the Deputy Secretary of Mental Health between the State = facility=20 and the Administrator which designates the State facility as:=20
     (i)   A substitute = provider of=20 inpatient services on a temporary basis when an emergency need arises = and=20 there are no other appropriate approved facilities available; or=20
     (ii)   A provider of=20 specialized forensic inpatient services when a need for security = arises.=20
   (4)  Such letter of agreement shall = define the=20 nature of security to be available and the responsibilities of both = the State=20 facility and the administrator.=20
(c)  When application is made to an approved = facility, the=20 director of the facility shall:=20
   (1)  Be responsible for insuring that a = preliminary evaluation of the applicant is conducted in order to = establish the=20 necessity and appropriateness of outpatient services or partial=20 hospitalization or inpatient hospitalization service for the = individual=20 applicant. The preliminary evaluation shall be done in the least = restrictive=20 setting possible. The results of the preliminary evaluation shall be = set forth=20 on Form MH-781-A issued by the Department.=20
   (2)  Promptly notify the administrator = if the=20 applicant=92s treatment will involve mental health/mental retardation = (MH/MR)=20 funding.=20
(d)  When application is made to the administrator: =
   (1)  The administrator shall designate = an=20 approved facility which shall conduct a preliminary evaluation of the=20 applicant in order to establish the necessity and appropriateness of=20 outpatient services or partial hospitalization service or inpatient=20 hospitalization for the individual applicant.=20
   (2)  The designated facility shall = immediately=20 upon its completion of the preliminary evaluation, notify the = administrator of=20 its finding and recommendations.=20
   (3)  Upon receipt of the report, the=20 administrator shall review the report and when necessary, designate an = approved appropriate facility for the recommended treatment of the = individual=20 applicant.
=A7 5100.73. Explanation and = consent to=20 inpatient treatment.

(a)  In order to assure that a person substantially = understands the nature of voluntary inpatient treatment, an = explanation shall=20 be made to him of the findings of the preliminary evaluation and the = proposed=20 treatment and goals. An explanation of planned diagnostic and = treatment=20 procedures, including the medications, restraints or restrictions = which may be=20 utilized shall be given in terms understandable by the person seeking=20 services.=20
(b)  Each applicant shall be provided with a copy = of the=20 Patient=92s Bill of Rights. Form MH-782 or the Patient=92s Rights = Pamphlet, PWPE=20 #605 entitled You Have a Right To Be Treated With Dignity and = Respect.=20 Consent shall be obtained by use of Form MH-781 B, C or D.=20
(c)  In the event that the consent of the applicant = is=20 given but cannot be obtained in writing, a statement on a form = approved by the=20 Department documenting that the applicant acknowledged the explanation = given=20 indicated his or her consent shall be signed by the person presenting = the=20 information and at least one witness. This statement shall be made = part of the=20 patient=92s record.=20
(d)  Staff of a facility, in arranging to convert a = person=92s legal status from involuntary treatment under civil = commitment to=20 voluntary treatment under Article II of the act (50 P. S.=20 =A7 =A7  7201=977207), shall explain to the patient = that he, by=20 converting to voluntary status, is agreeing to remain in treatment for = 72=20 hours after giving proper notice of his intent to withdraw from = treatment. A=20 patient=92s refusal to agree to remaining in treatment for this = 72-hour period=20 may be considered as sufficient grounds to deny the conversion and = seek a new=20 commitment. The conversion process for persons in involuntary = treatment who=20 are under criminal jurisdiction shall be arranged in accordance with = the steps=20 outlined in section 407 of the act (50 P. S. =A7  7407), and = this=20 chapter.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.71=20 (relating to voluntary examination and treatment). =
=A7 5100.74. Notice to parents = regarding=20 voluntary inpatient treatment of minors.

(a)  A notice to parents, guardian, or person = standing in=20 loco parentis of the patient age 14 to 18 of acceptance for = treatment=20 shall be given by telephone when possible, and also by delivery of = Form MH-781=20 issued by the Department. The notice shall include an explanation of = the=20 proposed treatment and the right to be heard upon the filing of an = objection.=20
(b)  Whenever the director of the facility is = unable to=20 determine the whereabouts of the parents, guardian, or person standing = in=20 loco parentis, he shall take such action as he deems = appropriate,=20 including notifying appropriate child welfare agencies.=20
(c)  In the event that a parent, guardian, or = person=20 standing in loco parentis objects to the voluntary examination = and=20 treatment, he may file an objection in writing with the director of = the=20 facility or the administrator, who shall arrange for a hearing under = the act.
=A7 5100.75. Physical examination = and=20 formulation of individualized treatment plan.

(a)  Upon completion of the preliminary evaluation = and=20 acceptance of a person for voluntary inpatient examination or = treatment, the=20 facility shall provide or arrange for a physical examination = immediately,=20 unless one has immediately been conducted as part of the preliminary=20 evaluation that is acceptable to the facility.=20
(b)  A preliminary treatment plan, based upon the=20 preliminary examination, may be used initially and shall be revised = under=20 =A7  5100.15 (relating to contents of treatment plan), at = the earliest=20 opportunity.
=A7 5100.76. Notice of = withdrawal.

(a)  Upon request to any clinical employe of the = treating=20 facility, a person 14 years of age or older seeking release from = voluntary=20 treatment shall be immediately provided with Form MH-781-F issued by = the=20 Department. Unless otherwise indicated in the patient=92s record, the = treatment=20 team leader shall be notified of each request to withdraw. An adequate = supply=20 of Form MH781-F shall be available in all treatment and living areas = of the=20 facility.=20
(b)  The person receiving a signed Form MH 781-F = from a=20 patient shall immediately examine the patient=92s record to determine = whether=20 the patient has previously agreed to remain in treatment for a = specified=20 period not to exceed 72 hours after having given written notice of = intent to=20 withdraw from involuntary treatment. If no such consent has been = given, the=20 patient may immediately withdraw from treatment unless an application = for=20 emergency involuntary treatment is executed under section 302 of the = act (50=20 P. S. =A7  7302), and the patient is advised accordingly.=20
(c)  If consent to remain in treatment had been = given, the=20 person examining the record shall notify the patient and a member of = the=20 treatment team or their designee, who shall be available at all times. = The=20 treating facility may delay release of such person for a period not = exceeding=20 that specified if the treatment team or its designee has reason to = believe=20 that:=20
   (1)  The individual is severely = mentally=20 disabled and a petition for involuntary treatment under section 302 of = the act=20 (50 P. S. =A7  7302), is to be filed before the end of the = specified=20 time period; or=20
   (2)  Immediate release would be = medically=20 dangerous to the health of the individual.=20
(d)  The patient need not be released until = determinations=20 in subsections (b) and (c) can be rationally made and until the = treatment team=20 leader or designee has had an opportunity to talk with the patient.=20
(e)  When release of an individual from voluntary = treatment=20 is delayed, the individual shall be informed of the circumstances = justifying=20 the delay for the specified period of time. The circumstances shall = also be=20 set forth in writing and made part of the patient=92s record. = Treatment shall be=20 provided during this period only with consent or as necessary to treat = an=20 emergency.=20
(f)  Rules relating to delayed release apply to = release of=20 persons under the age of 14 who are admitted under a delayed release=20 admission.=20
(g)  The director of the facility shall notify the=20 administrator of the withdrawal of any publicly funded person from = voluntary=20 treatment as soon as possible after receiving notice from the person = of his=20 intent to withdraw from treatment. The director of a State medical = health=20 facility shall designate staff to make a continuity of care referral = to the=20 appropriate administrator and to participate in the development of = follow-up=20 plans for persons withdrawing from involuntary treatment.=20
(h)  A person who is a voluntary admission from a = prison or=20 jail shall not be discharged upon his request. If the facility concurs = with=20 the person=92s request to withdraw from treatment:=20
   (1)  Nonemergency or nonconsensual = treatment=20 shall be suspended.=20
   (2)  The person may be detained for the = reasonable time necessary for the correctional facility to arrange for = the=20 person=92s transportation. Normally, transportation should be arranged = and=20 completed within 72 hours of the request to withdraw from = treatment.

Cross References

   This section cited in 55 Pa. Code = =A7  13.8=20 (relating to seclusion).
=A7 5100.77. Discharge from = voluntary=20 inpatient treatment.

(a)  In the event that the treatment team = determines that=20 continued voluntary inpatient treatment is not indicated, the = treatment team=20 shall discharge the patient with an appropriate post-discharge plan. = If public=20 funds are or will be involved, the director shall notify the = administrator as=20 early as feasible of the discharge plan. All persons being discharged = from a=20 State operated mental health facility shall be referred to the = administrator=20 per section 116 of the act (50 P. S. =A7  7116).=20
(b)  In the event that any patient in voluntary = inpatient=20 treatment is unwilling to accept or cooperate with his individualized=20 treatment plan, the treatment team shall advise the director of the = facility=20 of such fact. The director of the facility or designee shall review = the=20 circumstances including the availabilities of reasonable alternative = treatment=20 plans, and determine whether discharge is appropriate.=20
(c)  When the director of the facility determines = that the=20 unwillingness of the patient to accept or cooperate with the = individualized=20 treatment plan, or reasonable alternative treatment plans, makes = continued=20 voluntary inpatient treatment inappropriate, he or she shall advise = the=20 patient of the voluntary nature of the treatment and the patient=92s = right to=20 withdraw.=20
(d)  In the event that the patient continues to = fail to=20 accept or cooperate with the individualized treatment plan or = reasonable=20 alternative treatment plan, and fails to withdraw from voluntary = inpatient=20 treatment, the director of the facility shall advise the patient, and = if=20 public funds are involved, the Administrator, of his determination = that=20 discharge or commitment may be appropriate. =
=A7 5100.78. Transfer of persons = in voluntary=20 treatment.

(a)  A transfer initiated by the patient in = voluntary=20 treatment, his family, a facility director, or county administrator, = under the=20 act shall only be to approved facilities and with use of Form MH-60.=20
(b)  Each person 14 years of age or older, or the = parent,=20 guardian, or person standing in loco parentis of a person under = 14=20 years of age who is in voluntary treatment and is considered for = transfer from=20 one facility to another, shall be informed about the prospective = treatment=20 setting and modalities before giving written consent. For a person 14 = to 17=20 years of age, notice of the proposed transfer shall be sent to the = person=92s=20 parents indicating their right to object by requesting a hearing. When = the=20 transfer will result either in placing the person in a more = restrictive=20 setting, or in placing greater restrictions upon the person, these = facts shall=20 be explicitly explained to the person and his parents prior to = obtaining a=20 consent. Written consent shall be obtained prior to the release of any = records=20 for the purpose of planning or effecting a transfer.=20
(c)  All necessary actions required to effect a = voluntary=20 transfer remain the responsibility of the patient in voluntary = treatment, or=20 his relatives, or both, and the releasing and accepting facilities = unless=20 there are requirements or conditions for authorization imposed by a = county=20 administrator or by order of court.=20
(d)  Transfers of persons in voluntary treatment = from State=20 operated mental health facilities to another State may be arranged by = the=20 patient or his relatives, or both, by discharge and admission = procedures of=20 the respective facilities, or if necessary, a transfer may be made = through the=20 Interstate Compact Officer after consent has been obtained under = subsection=20 (b).=20
(e)  Except for persons admitted to voluntary = treatment=20 under section 401 of the act (50 P. S. =A7  7401), transfers = of=20 persons in voluntary treatment to State operated mental health = facilities from=20 another State through the patient=92s own resources or through the = Interstate=20 Compact may be made after the consent in subsection (b) has been = obtained.=20
(f)  For purposes of this section and = =A7  5100.90=20 (relating to transfer of persons in involuntary treatment), a State = mental=20 hospital or private psychiatric hospital shall be considered a single=20 facility, except that those distinct parts of State mental hospitals=20 designated as either forensic units or intermediate care units shall = be=20 considered a distinct facility. =

INVOLUNTARY TREATMENT

=A7 5100.81. Involuntary = examination and=20 treatment.

(a)  A person may be subject to an involuntary = examination=20 only at facilities approved and designated for that purpose by the=20 administrator.=20
(b)  No facility shall be designated unless it has = an=20 approved plan to comply with section 302(c)(2) of the act (50 P. S.=20 =A7  7302(c)(2)), and this chapter. The plan shall be = jointly=20 developed by the administrator and facility director, utilizing = available=20 county resources.=20
(c)  The administrator, at least on an annual = basis, shall=20 advise the public, through notice in one newspaper of general = circulation in=20 the county, of the facilities he has designated to provide involuntary = emergency examination and treatment. =
=A7 5100.82. Jurisdiction and = venue of legal=20 proceedings.

(a)  A court ordering involuntary treatment may = retain=20 jurisdiction over subsequent proceedings. If jurisdiction is initially = exercised by the court of the county in which the person is, = jurisdiction=20 shall be transferred to the county of the person=92s most current = residence=20 except in cases committed under section 401 of the act (50 P. S.=20 =A7  7401). For persons committed under section 401 of the = act,=20 jurisdiction shall be transferred to the court having jurisdiction = over the=20 person=92s criminal status. Security provisions for a person committed = under=20 section 401 of the act may be reduced only by the court with = jurisdiction over=20 the person=92s criminal status.=20
(b)  Hearings may be held at facilities in all = cases. In=20 light of the difficulties involved in transporting patients and staff, = and the=20 impact upon patient care, every effort shall be made to hold hearings = at the=20 facility.=20
(c)  Records of hearings shall be confidential as = part of=20 the patient=92s records.
=A7 5100.83. Generally.

(a)  A person may be subject to an involuntary = examination=20 only at facilities approved and designated for that purpose by the=20 administrator.=20
(b)  No facility shall be designated unless it has = an=20 approved plan to comply with section 302(c)(2) of the act (50 P. S.=20 =A7  7302(c)). The plan shall be jointly developed by the=20 administrator and facility director, utilizing available county = resources.=20
(c)  The administrator, at least on an annual = basis, shall=20 advise the public, through notice in one newspaper of general = circulation in=20 the county, of the facilities he has designated to provide involuntary = emergency examination and treatment. =
=A7 5100.84. Persons who may be = subject to=20 involuntary emergency examination and treatment.

(a)  Persons 14 through 17 years of age may be = subject to=20 involuntary emergency examination and treatment only in an approved = mental=20 health facility capable of providing a treatment program appropriate = to the=20 person. Persons 5 through 13 years of age may be subject to = involuntary=20 emergency examination and treatment only in an approved mental health = facility=20 capable of providing a treatment program appropriate to the child. = Persons=20 from birth through 4 years of age may be subject to involuntary = emergency=20 examination and treatment only in a mental health facility capable of=20 providing a treatment program appropriate to the child. Should no such = facility exist within the county of residence, the nearest appropriate = facility shall be designated by the county administrator. Longer term=20 involuntary treatment for the age groups listed in this section, must = be=20 conducted by agencies with age appropriate programs which are approved = by the=20 Department and designated by the county administrator when public = monies are=20 utilized for treatment.=20
(b)  Persons 18 years of age and older may be = subject to=20 involuntary emergency examination at an approved facility designated = for such=20 purpose by the administrator. Involuntary emergency treatment may be = provided=20 at the examining facility or any other designated and approved = facility=20 appropriate to the person=92s needs. Travel arrangements between the = examining=20 facility and the treating facility shall be arranged as needed as soon = as=20 possible to permit transportation appropriate to the person=92s needs. =
(c)  The determination of whether the standards of = clear=20 and present danger are met should always include a consideration of = the=20 person=92s probable behavior if adequate treatment is not provided on = either an=20 emergency or subsequent basis.=20
(d)  The standards of clear and present danger may = be met=20 when a person has made a threat of harm to self or others; has made a = threat=20 to commit suicide; or has made a threat to commit an act of mutilation = and has=20 committed acts in furtherance of any such threats.=20
(e)  Examining physicans should consider the = probability=20 that the person would be unable without care, supervision, and the = continued=20 assistance of others, to satisfy his need for nourishment, personal or = medical=20 care, shelter or self-protection, and safety in accordance with = section=20 301(b)(2)(i) of the act (50 P. S. =A7  7301(b)(2)(i)).=20
(f)  When the petition for commitment filed under = section=20 301(b)(2)(i) alleges that a person poses a clear and present danger to = himself, clinical or other testimony may be considered which = demonstrates that=20 the person=92s judgment and insight is so severely impaired that he or = she is=20 engaging in uncontrollable behavior which is so grossly irrational or = grossly=20 inappropriate to the situation that such behavior prevents him from = satisfying=20 his need for reasonable nourishment, personal care, medical care, = shelter or=20 self-protection and safety, and that serious physical debilitation, = serious=20 bodily injury or death may occur within 30 days unless adequate = treatment is=20 provided on an involuntary basis.=20
(g)  An attempt under sections 301(b)(2)(ii) and = (iii) of=20 the act (50 P. S. =A7  7301(b)(2)(ii) and (iii)), occurs:=20
   (1)  When a person clearly articulates = or=20 demonstrates an intention to commit suicide or mutilate himself and = has=20 committed an overt action in furtherance of the intended action; or=20
   (2)  When the person has actually = performed=20 such acts.

Notes of Decisions

   Jury Instructions=20
   Although the court did not charge the jury on = these=20 regulations which specify that a suicide attempt consists of an intent = to=20 commit suicide and an overt act in furtherance of the intended action, = there=20 was no error because 50 P. S. =A7  7301 fully and accurately = conveyed=20 the applicable law. Mertz v. Temple University Hospital, 29 = Phila. 467=20 (1995).=20
   Suicide=20
   The writing of suicide notes can be considered an = overt=20 act in furtherance of a suicide. Mertz v. Temple University = Hospital,=20 29 Phila. 467 (1995).=20
   A psychiatrist who discharged a patient brought = to a=20 hospital=92s psychiatric emergency room for involuntary commitment = under the=20 Mental Health Procedures Act (50 P. S. = =A7 =A7  7101=977503), was=20 held liable to three minors injured when the patient blew up a row = house while=20 committing suicide. Mertz v. Temple University Hospital, 29 = Phila. 467=20 (1995).
=A7 5100.85. Standards.

The standards of section 301 of the act (50 P. S. = =A7  7301),=20 for determination of severe mental disability and present danger are = to be=20 applied so as to determine whether emergency commitment is necessary = under=20 section 302 of the act (50 P. S. =A7  7302), or whether a=20 court-ordered commitment under section 304(c) of the act (50 P. S.=20 =A7  7304(c)), is appropriate:=20
   (1)  The application of the standards = in=20 section 301 of the act, for emergency commitment, including the = requirement of=20 overt behavior, shall be based at least upon the following factors:=20
     (i)   There is a = definite need=20 for mental health intervention without delay to assist a person on an=20 emergency basis;=20
     (ii)   The clear and = present=20 danger is so imminent that mental health intervention without delay is = required to prevent injury or harm from occurring;=20
     (iii)   There is = reasonable=20 probability that if intervention is unduly delayed the severity of the = clear=20 and present danger will increase; or=20
     (iv)   There is = reasonable=20 probability that the person, with his presently available supports, = cannot=20 continue to adequately meet his own needs if mental health = intervention is=20 unduly delayed.=20
   (2)  The application for the standards = under=20 section 301 of the act for a court-ordered commitment, including the=20 requirement of overt behavior under section 304(c) of the act (50 P. = S.=20 =A7  7304(c)), shall be based upon the following factors, = among=20 others:=20
     (i)   There is no = emergency=20 basis and mental health intervention may be delayed;=20
     (ii)   The clear and = present=20 danger is not so imminent that intervention without delay is necessary = to=20 protect life and limb;=20
     (iii)   There is = reasonable=20 probability that the severity of the clear and present danger is = sufficiently=20 low that emergency intervention without delay is unnecessary; or=20
     (iv)   There is = reasonable=20 probability that the person can continue to meet his needs; however,=20 marginally, by utilizing his presently available supports until a = hearing=20 under section 304 of the act (50 P. S. =A7  7304), can be = conducted.
=A7 5100.86. Involuntary = emergency=20 examination and treatment not to exceed 120 hours.

(a)  Written applications, warrants, and written = statements=20 made under section 302 of the act (50 P. S. =A7  7302), = shall be made=20 on Form MH-783 issued by the Department.=20
(b)  A State-operated facility shall not accept an=20 application for involuntary emergency examination and treatment unless = there=20 is a preexisting agreement of waiver approved by the Deputy Secretary = of=20 Mental Health, between the State facility and the administrator which=20 designates the State facility as the only provider of inpatient = services in=20 the county program; or, there is a preexisting letter of agreement = approved by=20 the regional commissioner of mental health, between the State facility = and the=20 administrator which designates the State facility as:=20
   (1)  A substitute provider of inpatient = services when an emergency need arises and there are no other = appropriate and=20 approved facilities available; or=20
   (2)  A provider of specialized forensic = inpatient services when a need for security arises. Such letters of = agreement=20 shall define the nature of security to be available and the = responsibilities=20 of both the State facility and the Administrator for specific services = including aftercare planning and referral.=20
(c)  Any person authorized under section 302 of the = act to=20 take a person to a treatment facility for involuntary emergency = examination=20 and treatment shall explain to the person in need of such examination = and=20 treatment the nature and purpose of the action to be undertaken.=20
(d)  The escorting individual shall make every = effort to=20 use the least force necessary and shall act to the extent possible in = a=20 courteous manner toward such individual giving attention to the = dignity of the=20 person. Transportation to and from a facility remains the ultimate=20 responsibility of the administrator.=20
(e)  Upon arrival at a facility previously = designated as a=20 provider of emergency examinations. Form MH-783 shall be completed and = Form=20 MH-783-B shall be given to the person subject to the examination. The = person=20 shall be informed of his right to counsel and be advised that if he = cannot=20 afford counsel, counsel can be provided.=20
(f)  If the examining physician determines that the = person=20 is not severely mentally disabled or not in need of immediate = treatment, the=20 administrator shall be notified of the results of the examination and = shall=20 assure that the person is provided with transportation to an = appropriate=20 location within the community, as he may request.=20
(g)  If the person is determined to be severely = mentally=20 disabled and in need of immediate treatment:=20
   (1)  The examining physician shall make = certain=20 that the person has received a copy of forms MH-782, Bill of Rights, = and=20 MH-783-A, Explanation of Rights Under Involuntary Emergency = Commitment.=20
   (2)  The facility shall notify the=20 administrator, if applicable, that:=20
     (i)   No warrant has = been=20 issued and there is reasonable probability that a previous = application, based=20 upon the same behavior, had been sought;=20
     (ii)   A bed is needed = at=20 another facility; or=20
     (iii)   Public funding = will be=20 involved.=20
   (3)  When the examining facility = recommends=20 emergency involuntary treatment and has no bed available, the = administrator in=20 designating a facility for treatment, shall also authorize = transportation=20 between facilities.=20
(h)  The administrator shall designate an = appropriate=20 treatment facility which may be the examining facility or, if no bed = is=20 available there, the nearest appropriate facility which is capable of=20 immediately providing such treatment. If county OMH funding is not = involved,=20 the patient=92s choice of facilities is to be respected whenever an = appropriate=20 bed is available.=20
(i)  The involuntary emergency treatment of the = individual,=20 or the arrangement of such, shall be initiated immediately but shall = be=20 limited to:=20
   (1)  Conducting a physical examination. =
   (2)  Performing diagnostic evaluations = of the=20 individual=92s mental health.=20
   (3)  Providing that necessary treatment = required to protect the health and safety of the individual and = others. As a=20 first priority, the treating physician shall seek to respond to the = emergency=20 condition necessitating commitment unless the individual consents to=20 additional treatment.=20
(j)  Examination preliminaries.=20
   (1)  The facility shall deliver Forms = MH-782,=20 and MH-783-A to each person to be examined and shall inform him or her = of the=20 purpose and nature of the examination.=20
   (2)  The person shall be requested to = furnish=20 the names of up to three parties whom he may want notified and kept = informed=20 of his status. The parties may, at the request of the patient, be = informed of=20 any major change in the person=92s status, including transfer, escape, = major=20 change in medical condition or discharge.=20
   (3)  The person shall be informed of = his right=20 to counsel.=20
   (4)  Reasonable use of the telephone = shall mean=20 at least three completed phone calls. If assistance is required, the = facility=20 shall assist the individual in completing phone calls. The cost of any = toll=20 calls shall be borne by the person in need of treatment, although = actual=20 payment shall not be a precondition to the person=92s use of the = telephone.=20
   (5)  The treating facility shall = immediately=20 undertake to obtain information regarding what steps should be taken = to assure=20 that the health and safety needs of any dependents of the person are=20 safeguarded and that his personal property and premises are secured.=20
   (6)  The facility shall immediately = communicate=20 the information obtained to the office or person designated by the=20 administrator.=20
   (7)  Before any facility is designated = as the=20 provider of involuntary emergency examination and treatment, the = administrator=20 shall have specified in writing the procedures to be followed by his = office=20 and those facilities to be designated in carrying out of the = responsibilities=20 of section 302(c)(2) of the act (50 P. S. =A7  7302(c)(2)). = These=20 procedures must specify what types of reasonable actions shall be = taken, how=20 quickly they shall be taken, and who is responsible for them. Such = procedures=20 shall be based on the availability of resources within the community.=20
   (8)  The administrator=92s office shall = coordinate and record any action taken in each case. At least annually = the=20 administrator and each approved facility shall review and consider = needed=20 amendments to the procedures.=20
(k)  Reasonable steps to assure that the health and = safety=20 needs of a person=92s dependents are met and the property is secure.=20
   (1)  The actions of a facility director = or=20 county administrator taken under section 302(c)(2) of the act should = be well=20 defined, and reflective of local resources.=20
   (2)  Because of community differences, = no one=20 Statewide plan can serve all possible contingencies. The act = comtemplates that=20 reasonable efforts be taken to assure protection of person=92s = dependents and=20 property. The efforts must, as a minimum include a documented = assessment of=20 the patient=92s need for protective services. This would mean that = those=20 initially working with a patient would attempt to determine what is = needed by=20 talking with the patient or his family or friends. Once the = information is=20 gathered, it should be transmitted to the person responsible for=20 implementation of protective services or if incomplete, this fact = should be=20 transmitted to those responsible for a more thorough assessment. The = act does=20 not contemplate that mental health professionals will actually provide = all=20 needed services for all patients but relies upon professional linkage = referral=20 and follow-up to assure that the needed protections are in fact, = provided and=20 maintained. The implementation of protective services requires = community=20 organization efforts by the county administrator=92s office in = developing=20 interagency liaison on continuing basis.=20
   (3)  Each mental health administrative = unit=20 should develop its own plan which addresses the most typical or usual=20 contingencies. State in the plan that deviations will be handled on a=20 case-by-case basis. The most essential element in meeting the = requirement of=20 this section is for the county administrator to have a well-developed = local=20 plan which shows the involvement of all possible resources, such as = local=20 health, welfare, housing agencies, and protective services determines = which=20 individuals, or agencies are responsible for particular activities and = when=20 they are to be involved. The plan should show initial procedures for = involving=20 the patient=92s family, legally responsible relatives, or friends = designated by=20 the patient. Agencies should be utilized only as necessary. The plan = should=20 define the communication flow and the specific duties and = responsibilities for=20 action of the mental health provider agencies, the administrator=92s = office, and=20 protective agencies. The plan should also indicate general provisions = for the=20 resolution of problems and how exceptional cases will be provided for. =
   (4)  Once a referral is made and the=20 information is conveyed to the appropriate agencies, the only = remaining=20 responsibility for the administrator is the periodic follow up = necessary to=20 demonstrate that the protection continues to be made available to the = patient=20 in need.=20
   (5)  Plans developed under this section = should=20 be reviewed at least annually by the participating agencies and will = be=20 subject to review and approval by the office of Mental Health.

Notes of Decisions

   Under the terms of the Mental Health and Mental=20 Retardation Act of 1966 and the Mental Health Procedures Act, when a = court=20 orders treatment at a designated State mental hospital, the designated = facility must admit the patient for treatment; at that time, the = facility is=20 without recourse to deny admission. In re Bishop, 717 A.2d 1114 = (Pa.=20 Cmwlth. 1998).
=A7 5100.87. Extended involuntary = emergency=20 treatment not to exceed 20 days.

(a)  Within 72 hours after initiation of emergency=20 involuntary treatment, the treating facility shall reassess the mental = condition of the individual receiving treatment and shall determine = whether=20 the need for involuntary emergency treatment is likely to extend = beyond the=20 initial 120 hours.=20
(b)  Extended involuntary emergency treatment may = include=20 inpatient, partial hospitalization, outpatient or a combination of = treatment=20 modalities. In determining whether to extend the emergency involuntary = treatment, the treatment team shall consider:=20
   (1)  The need for involuntary = commitment.=20
   (2)  The optimal modality or setting = for=20 continued treatment.=20
(c)  If the facility determines that extended = emergency=20 involuntary treatment is necessary, the facility shall:=20
   (1)  Immediately notify the person that = an=20 application for extended involuntary treatment will be filed and that = the=20 court will appoint an attorney to represent the person unless it = appears that=20 the person can afford and desires to have private representation.=20
   (2)  Immediately deliver an application = upon=20 Form MH-784 to the court or Mental Health Review Officer through the=20 administrator=92s office. Alternatively, any responsible person who = has been=20 involved in the emergency commitment process may act as petitioner.=20 Applications need not be filed with or docketed by the prothonotary = where the=20 court so approves. If necessary, the court will appoint counsel for = the=20 patient.=20
   (3)  Immediately deliver an application = upon=20 Form MH-784 to the person subject to the proceedings and notify the = parties=20 identified by the person.=20
(d)  Informal conference. The treatment facility = shall=20 present to the judge or mental health review officer all information = it=20 considers reliable and relevant to the determination as to whether the = person=20 is severely mentally disabled and in need of emergency treatment. The=20 conference shall be informal, but conducted with decorum. Relevant = information=20 includes:=20
   (1)  Evidence of a person=92s conduct = upon which=20 a determination of mental disability may be based. If the alleged = conduct=20 constituting clear and present danger has occurred within 30 days = relevant=20 conduct prior to the 30 day period may be presented:=20
   (2)  The reasons why extended = involuntary=20 treatment is considered necessary.=20
   (3)  A description of the treatment to = be=20 provided.=20
   (4)  An explanation of the adequacy and = appropriateness of such treatment for the individual, including why = such=20 treatment poses the least restrictive alternative for the individual.=20
   (5)  Any other relevant information = even if it=20 would be normally excluded under rules of evidence may be offered to = the judge=20 or mental health review officer who will review such information if he = or she=20 believes it is reliable. Only in rare instances need a stenographic = record be=20 taken of the proceedings required under this section.=20
(e)  Certification for extended emergency = involuntary=20 treatment.=20
   (1)  Certification for extended = emergency=20 involuntary treatment shall be made in writing on Form MH-784, issued = by the=20 Department.=20
   (2)  A certification filed and served = shall=20 remain in effect notwithstanding a petition for review of the = certification,=20 unless otherwise ordered by the court.=20
   (3)  Descriptions of proposed treatment = shall=20 be considered advisory only and shall be changed by the treatment team = as the=20 patient=92s condition warrants.=20
(f)  The opportunity for a person on involuntary = inpatient=20 status to receive treatment in an approved less restrictive program = such as=20 involuntary partial hospitalization or outpatient services may be = accomplished=20 through a transfer under section 306 of the act (50 P. S. = =A7  7306).=20 A commitment certification does not become void when a transfer from = one=20 program to another is executed.=20
(g)  If the facility determines that extended = emergency=20 involuntary treatment is not necessary, it shall either accept the = person for=20 voluntary inpatient treatment or discharge the person and facilitate = the=20 person=92s obtaining:=20
   (1)  Voluntary treatment at the = facility best=20 equipped to meet his needs.=20
   (2)  Report the person=92s change of = status and=20 follow-up recommendations by referral for continuity of care to the = county=20 administrator, or both.

Notes of Decisions

   Although the MH784 form documenting certification = had=20 been completed only in abbreviated manner, that was adequate to = fulfill the=20 intent of the statute and the demands of the pertinent regulations. = In Re:=20 S.O., 492 A.2d 727 (Pa. Super. 1985).

Cross References

   This section cited in 55 Pa. Code = =A7  5100.88=20 (relating to court-ordered involuntary treatment not to exceed 90 = days); 55=20 Pa. Code =A7  5100.89 (relating to additional periods of = court-ordered=20 involuntary treatment not to exceed 180 days). =
=A7 5100.88. Court-ordered = involuntary=20 treatment not to exceed 90 days.

(a)  A petition for court-ordered treatment under = section=20 304 of the act (50 P. S. =A7  7304), shall not be filed for = a person=20 held for involuntary emergency examination and treatment under section = 302 of=20 the act (50 P. S. =A7  7302), without first proceeding under = section=20 303 of the act (50 P. S. =A7  7303).=20
(b)  Initiation of court-ordered involuntary = treatment for=20 persons already subject to involuntary treatment.=20
   (1)  The director of the facility, the = county=20 administrator, or any responsible person with knowledge of the = patient=92s=20 mental condition may serve as petitioner.=20
   (2)  If the director of the facility = determines=20 that continuing involuntary treatment is not needed, he shall notify = the=20 county administrator or other appropriate person of this decision or a = change=20 in status 10 days before the expiration of the involuntary treatment=20 previously authorized.=20
   (3)  If the director of the treating = facility=20 determines that continued involuntary treatment of a person already = subject to=20 involuntary treatment is necessary, he shall notify the administrator = of such=20 fact by filing Form MH-785.=20
   (4)  The petition for court-ordered = involuntary=20 treatment for persons already subject to involuntary treatment shall = be filed=20 not less than 5 days prior to the expiration of the involuntary = treatment=20 previously authorized. The petition shall be sufficient if it = represents that=20 the conduct originally established to subject the person to = involuntary=20 treatment did in fact occur and that the person=92s condition = continues to=20 evidence a clear and present danger to himself or others. It shall not = be=20 necessary to show the recurrence of the dangerous conduct, either = harmful or=20 debilitating, within the past 30 days.=20
   (5)  The petitioner shall immediately = notify=20 the person of the intent to file a petition for court-ordered = involuntary=20 treatment with the court of common pleas by delivering to such person = Form=20 MH-785-A issued by the Department. The director of the facility may = assist the=20 petitioner in notifying the person in treatment of the intent to file = a=20 petition and in serving the papers. The material given to the person = shall=20 include an explanation of the nature of the proceedings and the = person=92s right=20 to counsel under =A7  5100.87(c)(1) (relating to extended = involuntary=20 emergency treatment not to exceed 20 days), and the right to the = services of=20 an expert in mental health.=20
(c)  Initiation of court-ordered involuntary = treatment for=20 persons not presently subject to involuntary treatment.=20
   (1)  A petition for court-ordered = involuntary=20 treatment for a person not already in involuntary treatment shall be = made upon=20 Form MH-785 issued by the Department. If the petition is filed by the = director=20 of a facility or the administrator for a person already in voluntary=20 treatment, it shall state the name of an examining physician and the = substance=20 of his opinion regarding the mental condition of the person. In all = other=20 cases, the petition shall state the name of an examining physician, if = any,=20 and the substance of his opinion regarding the mental condition of the = person.=20
   (2)  If a decision to file a petition = for=20 court-ordered involuntary treatment is made by the director of a = facility for=20 a person already in voluntary treatment, the director shall = immediately notify=20 the administrator, if the decision to file is made by the = administrator for a=20 person in voluntary treatment, the administrator shall immediately = notify the=20 director of the facility. In either case, the director shall notify = the person=20 in voluntary treatment of the decision to file a petition for = court-ordered=20 involuntary treatment by delivering to such person a copy of Form = MH-786-A=20 issued by the Department.=20
   (3)  The notice given to a person not = already=20 in involuntary treatment referred to in section 304(c)(4) of the act = (50 P. S.=20 =A7  7304(c)(4)) advising him of the right to counsel and = the=20 assistance of an expert in the field of mental health may be provided = by the=20 use of Form MH-785-B.=20
(d)  Duration of court-ordered involuntary = treatment except=20 for those under criminal jurisdiction:=20
   (1)  For persons committed for a period = not to=20 exceed 90 days, a person subject to court-ordered involuntary = treatment shall=20 be discharged whenever the director of the facility concludes that the = person=20 is no longer in need of continued inpatient treatment. A person may be = transferred under section 306 of the act (50 P. S. = =A7  7306) from=20 inpatient treatment to outpatient or partial hospitalization services = and=20 remain subject to involuntary commitment.=20
   (2)  A person may be committed for = treatment in=20 an approved facility under this section as inpatient, outpatient, or=20 combination of such treatment as the director of the facility shall = determine=20 under sections 304(f) and 306 of the act (50 P. S. = =A7 =A7  7304(f)=20 and 7306).=20
   (3)  For persons committed under = section=20 304(g)(2) of the act (50 P. S. =A7  7304(g)(2)), the = facility shall=20 require the treatment team to report every 90 days whether the person = is or=20 continues to be in need of treatment. This report shall be reviewed by = the=20 director of the facility and forwarded to the committing court. If the = treatment team finds that the person is no longer in need of = treatment, they=20 shall recommend to the director of the facility that the person be = discharged.=20 Whenever the director of a facility plans to discharge a patient = committed=20 under section 304(g)(2) of the act prior to the termination of a = court-ordered=20 period of involuntary treatment or whenever the director of a facility = plans=20 to release such a person at the expiration of court-ordered treatment, = the=20 director of the facility shall, at least 10 days prior to the = discharge or=20 expiration of the existing commitment, petition the court for the = conditional=20 or unconditional release of the person. The director shall give copies = of the=20 request for release to the person of residence and the district = attorney.=20 Notice of such action shall be given if appropriate to the sending = jail or=20 correctional facility.
=A7 5100.89. Additional periods = of=20 court-ordered involuntary treatment not to exceed 180 days.

(a)  When it is determined that additional periods = of=20 court-ordered involuntary treatment will be sought, the proceedings in = =A7  5100.87 (relating to extended involuntary emergency = treatment not=20 to exceed 20 days), shall be followed:=20
(b)  An application for an additional period of=20 court-ordered involuntary treatment shall be filed not less than 10 = days prior=20 to the termination of the court-ordered involuntary treatment period. = With all=20 such filings, the director shall have notified the appropriate = administrator=20 prior to the time of filing the proposed plan.=20
(c)  Occurrence of specific conduct constituting = clear and=20 present danger under section 301 of the act (50 P. S. = =A7  7301), is=20 not required to demonstrate the need for continuing involuntary = treatment.=20
(d)  Relevant factors in determining the need for = continued=20 involuntary treatment include, among others, the following:=20
   (1)  The person=92s willingness to = participate in=20 voluntary treatment.=20
   (2)  The continuing presence of the = condition=20 for which the individual has been receiving treatment.=20
   (3)  Any dangerous or debilitating = conduct=20 during the most recent period of treatment.=20
   (4)  The availability of outpatient = placement=20 and the likehood that the patient will take advantage of such = treatment.=20
   (5)  The availability of community = resources=20 and supports to assist the person in a less restrictive setting.=20
(e)  When an application is made for an additional = period=20 of court-ordered involuntary treatment for persons under criminal=20 jurisdiction, notice shall be sent to the warden or superintendent of = the=20 correctional facility to which the person otherwise would be returned. =
=A7 5100.90. Transfers of persons = in=20 involuntary treatment.

(a)  When the treatment team or director of a = facility, or=20 both, determine that a transfer of a person in involuntary treatment = is=20 appropriate, they shall notify the county administrator of the planned = transfer, setting out the reasons for the transfer which shall then be = reviewed by the county administrator to determine whether the = appropriate=20 services are available and to arrange for continuity of care if the = person is=20 referred from a State mental health facility.=20
(b)  Where a transfer of a person in involuntary = treatment=20 will involve a transfer to another county, the county administrator of = the=20 receiving county will be notified, and shall review the transfer as in = subsection (a).=20
(c)  Transfers of persons in involuntary treatment = may only=20 be made to an approved facility during the term of any given = commitment unless=20 there is a court order prohibiting such an action.=20
(d)  A patient=92s transfer from inpatient to = partial=20 hospitalization or outpatient facilities or programs, or from a = partial=20 program to an outpatient program, does not affect the original = involuntary=20 commitment order. Where a patient=92s transfer will result in greater = restraints=20 being placed upon the patient, the transfer shall occur only after a = hearing=20 when it is determined that the transfer is necessary and supportive to = the=20 patient=92s treatment plan.=20
(e)  For purposes of this section, an entire State = hospital=20 or private psychiatric hospital shall be considered to be one = facility, except=20 for those distinct parts designated as either forensic units or = intermediate=20 care units.=20
(f)  Transfers within the mental health system of = persons=20 admitted or committed from a prison or correctional facility shall not = be=20 effected without approval of the court having criminal jurisdiction = over the=20 person.=20
(g)  Except in an emergency, persons in treatment = under=20 section 304(g)(2) of the act (50 P. S. =A7  7304(g)(2)), may = be=20 transferred if prior notice has been given to and no objection has = been=20 received with 20 days from the judge and district attorney from the = committing=20 court.=20
(h)  In an emergency and on a temporary basis, = persons in=20 treatment under section 304(g)(2) of the act, may only be transferred = for=20 acute medical treatment when life or health would be in immediate = danger=20 without such transfer. When such transfers are accomplished, the court = and=20 district attorney of the committing court must be notified. The = expected=20 duration of such transfer, security measures, and reasons for transfer = should=20 be described in the notice.=20
(i)  Transfers of persons in treatment under = section=20 304(g)(2) to a more secure facility in order to protect the person or = others=20 from life threatening behavior must be ordered by the court.=20
(j)  Interstate transfers of persons on involuntary = commitment status shall be coordinated by the Department=92s Office of = Interstate Compact.

Cross References

   This section cited in 55 Pa. Code = =A7  5100.78=20 (relating to transfer of persons in involuntary treatment). =
=A7 5100.90a. State mental = hospital admission=20 of involuntarily committed individuals=97statement of policy.

(a)  To manage treatment resources more effectively = and=20 assure adequate Medical Assistance reimbursement to community general = and=20 private psychiatric hospitals for days of active treatment provided to = Medical=20 Assistance eligible persons with mental illness, appropriate action = shall be=20 taken by the affected parties. The following policy and procedures = should be=20 followed:=20
   (1)  Community general and private = psychiatric=20 hospital staff should notify via telephone appropriate county MH/MR=20 staff=97county administrator or designated agency=97upon Medical = Assistance=20 patients admission to the community general or private psychiatric = hospital.=20 This information may be released to county administrators under=20 =A7  5100.32(a)(5) (relating to nonconsensual release of = information).=20
   (2)  Immediately upon determination of = the need=20 for long-term psychiatric care, a referral package should be sent to = the=20 admissions unit of the State mental hospital (SMH) so it is received = at least=20 2 days prior to the date of the scheduled commitment hearing. The = County MH/MR=20 Administrator or their designated agency should be notified by the = community=20 general or private psychiatric hospital of the patient=92s need for = long-term=20 psychiatric care. The items to be included in the referral package=20 accompanying a patient on admission to a State hospital under sections = 304=97306=20 of the Mental Health Procedures Act (50 P. S. = =A7 =A7  7304=977306)=20 include:=20
     (i)   Signed and = completed=20 304/305/306 commitment papers.=20
     (ii)   Psychiatric = assessment.=20
     (iii)   Medical = assessment.=20
     (iv)   Current = medications.=20
     (v)   Laboratory and = X-ray=20 results.=20
     (vi)   Consultant=92s = reports.=20
     (vii)   Social history = with=20 special emphasis on family assessment and discharge resources.=20
     (viii)   Psychological = assessments=97if available.=20
     (ix)   BSU activity.=20
     (x)   Assessments from = other=20 clinical disciplines involved in the patient=92s treatment.=20
   (3)  The SMH admissions staff and the = staff of=20 the community general or private psychiatric hospital will agree upon = the date=20 that the patient will be admitted to the State hospital. The SMH = admissions=20 staff shall notify the community general or private psychiatric = hospital of=20 the agreed upon date of admission prior to the patient=92s scheduled = hearing=20 date.=20
   (4)  The community general or private=20 psychiatric hospital staff shall notify the hearing officer of the = date of=20 availability of a SMH bed.=20
   (5)  The hearing officer shall conduct = the=20 hearing in a timely fashion in accordance with the timeframes required = by the=20 Mental Health Procedures Act of 1976. A commitment order should = contain the=20 agreed upon admission date to the SMH.=20
   (6)  The community general or private=20 psychiatric hospital staff shall maintain appropriate documentation of = the=20 continuance of active treatment in the medical record until the = patient is=20 transferred to the SMH. Refer to =A7  1101.51 (d) and (e) = (relating to=20 ongoing responsibilities of providers) for the description of = appropriate=20 documentation of the continuance of active treatment.=20
   (7)  If the SMH bed is unavailable on = the=20 scheduled date of transfer, the SMH is responsible for contacting = other State=20 hospital facilities=97within a 75-mile radius=97to obtain a bed for = the patient.=20 If no bed is available in the surrounding SMHs, the initial SMH shall = contact=20 the next nearest SMH facility until a bed is found. SMH admissions = staff may=20 not deny access to a patient when a bed is available, except if, for = clinical=20 reasons, the clinical director deems the admission inappropriate. The = area=20 director is responsible for reviewing and monitoring denial of access = to other=20 State mental health facilities when a bed is available.=20
   (8)  The SMH will include in their = Letter of=20 Agreement with the county MH/MR program, the methodology used for = referring=20 patients to another SMH when a bed is not available. It is the intent = of the=20 Office of Mental Health to assure, whenever feasible, that the = patient=92s=20 treatment be in or near the patient=92s home community.=20
(b)  Medical Assistance should be able to reimburse = the=20 community general or private psychiatric facility for the eligible = days that=20 the Medical Assistance eligible patient is in the facility when the = policy and=20 procedures in subsection (a) are followed to include the following:=20
   (1)  The specific date of admission to = the SMH=20 appropriately documented on the court commitment.=20
   (2)  The continuance of active = treatment=20 adequately documented in the patient=92s medical record.=20
   (3)  The actual transfer of the patient = to the=20 SMH occurs on the date documented on the court commitment.

Source

   The provisions of this =A7  5100.90a = adopted=20 November 18, 1988, effective retroactively to November 9, 1988, 18 = Pa.B. 5168.=20

PERSONS CHARGED WITH A CRIME OR UNDER = SENTENCE

=A7 5100.91. General.

(a)  Any person subject to examination and = treatment under=20 section 401(a) of the act (50 P. S. =A7  7401(a)), may be = subject to=20 involuntary treatment under Article III of the act (50 P. S.=20 =A7 =A7  7301-7306), or may apply for voluntary = treatment under=20 =A7  5100.92 (relating to voluntary examination and = treatment of a=20 person charged with a crime or serving a sentence).=20
(b)  Whenever a person subject to treatment under = section=20 401(a) of the act is made subject to inpatient examination or = treatment, he=20 shall be transferred by the authority having jurisdiction to a = designated=20 approved facility after proceedings have been completed in accordance = with the=20 appropriate section of this chapter.=20
(c)  Any person who is subject to inpatient = examination or=20 treatment and who remains subject to a criminal detainer or sentence, = or who=20 is under the jurisdiction of the juvenile court, shall be returned to = the=20 custody of that authority upon their discharge from treatment.=20
(d)  Any person subject to inpatient examination = and=20 treatment shall be subject to any provisions of security imposed by = the=20 criminal juvenile court having jurisdiction, provided that the = facility to=20 which the person is being committed is capable of providing the = security. If=20 the facility is unable to provide the ordered security, the director = of the=20 facility shall immediately notify the court issuing the order. =
=A7 5100.92. Voluntary = examination and=20 treatment of a person charged with a crime or serving a sentence.

(a)  Whenever a person in criminal detention, = whether in=20 lieu of bail or when serving a sentence, believes he is in need of = treatment=20 and substantially understands the nature of voluntary treatment, he = may submit=20 himself to examination and treatment.=20
(b)  Prior to voluntary admission, at least one = physician,=20 preferably a psychiatrist where the person is in criminal detention, = shall=20 certify in writing the necessity for such treatment. This = certification shall=20 contain at least the following information:=20
   (1)  A statement that the person = substantially=20 understands the nature of inpatient treatment, including the nature of = his=20 mental illness or condition, and the requirement for continued = security if=20 admitted to a mental health facility.=20
   (2)  A statement that the patient is so = mentally ill as to require inpatient hospitalization and an = explanation why=20 outpatient management in the penal institution population by way of=20 psychotherapy with or without medication will not be sufficient.=20
   (3)  A description of the person=92s = condition,=20 symptoms, clinical history, and diagnosis.=20
(c)  The correctional facility shall secure a = written=20 acceptance of the person for inpatient treatment from a mental health=20 facility. This written acceptance shall contain at least the following = information:=20
   (1)  A statement that the inpatient = mental=20 health facility is willing and able to accept the person for = treatment.=20
   (2)  A description of the security = which the=20 inpatient mental health facility is able to provide.=20
(d)  The superintendent or warden of the = correctional=20 facility where the person is detained shall prepare a statement = concerning the=20 reasons for seeking treatment.=20
(e)  The person=92s written voluntary admission = request, the=20 physician=92s certification, the statement of the superintendent of = the=20 correctional facility regarding security needs, and the written = acceptance=20 from the mental health facility shall be forwarded to the president = judge of=20 the court of common pleas, in the county where the person was charged = or=20 sentenced.=20
(f)  The documents listed in subsections (b) = through (e)=20 shall be sent by certified mail, return receipt requested to:=20
   (1)  The judge in the court which = sentenced the=20 person. If it is determined the sentencing judge is no longer on the = bench,=20 the information shall be sent to the president judge.=20
   (2)  The district attorney of the = sentencing=20 county.=20
   (3)  The county administrator of the = sentencing=20 county.=20
(g)  The County Administrator of the county of the = person=92s=20 legal residence, if different from the person=92s county of sentence, = shall=20 receive notification by the correctional facility that the person has=20 requested voluntary admission to a mental health facility. This = notification=20 shall include the name of the proposed mental health facility and the = name of=20 the judge of the county of sentence to whom the voluntary request has = been=20 submitted.=20
(h)  Upon receipt of the request for voluntary = admission,=20 the district attorney of the county of sentence may, within 14 days = have a=20 physician conduct an independent examination of the applicant or file = a motion=20 contesting the need for treatment.=20
(i)  The Department will not participate in the = costs of=20 examination, transportation, or hearings incurred at the request of = the=20 distict attorney.=20
(j)  The court of common pleas for the judicial = district in=20 which the person is charged or sentenced shall have jurisdiction for = purposes=20 related to section 407 of the act (50 P. S. =A7  7407). = Where=20 possible, the sentencing judge shall preside.=20
(k)  Upon receipt of the request for voluntary = examination=20 and treatment, and upon review of the request, and its attendant = reports, and=20 following any hearing on the matter the court shall either approve or=20 disapprove the request.=20
   (1)  In the event the court approves = the=20 request for voluntary admission to a mental health facility, the court = shall=20 also indicate whether the conditions of security presented by the = inpatient=20 mental health facility are appropriate. If the court believes a = greater or=20 lesser degree of security is appropriate, it shall so direct.=20
(l)  The Department has designated Farview State = Hospital=20 as the Commonwealth=92s maximum security psychiatric facility. The = Department=20 has also designated Warren State Hospital, Mayview State Hospital, = Norristown=20 State Hospital, and Philadelphia State Hospital as having medium = security=20 forensic units for male patients. The general wards of State hospitals = and=20 most approved community mental health facilities can only provide the = same=20 degree of security as they do for civilly committed patients. = Regarding=20 placement for women, or questions regarding the appropriate level of = secure=20 placement for males, the regional mental health for the region in = which the=20 person is located should be contacted.=20
(m)  Whenever the court approves the request of the = person=20 charged with crime or undergoing sentence, the receiving mental health = facility, when space is available, shall accept the person and = immediately=20 proceed to examine the person and develop a detailed treatment plan.=20
   (1)  In the event the receiving = facility=20 determines that the person is unwilling to agree upon or participate = in a=20 treatment plan, or is unwilling to accept the security provisions = imposed by=20 the court, the mental health facility is to make arrangements with the = correctional institutes from which the person was transferred, to = effect the=20 person=92s immediate return to the correctional facility. The court = authorizing=20 the voluntary admission, the district attorney, and the county = administrator=20 of the county of residence, if different from the county of sentence, = are to=20 be sent notifications of this action by the mental health facility.=20
   (2)  If, at the time of the initial=20 examination, or anytime thereafter, the mental health facility is of = the=20 opinion that the patient requires more security than the facility can = offer=20 and the patient will not consent to his transfer to a more secure = facility the=20 sending correctional authority shall be contacted immediately in order = to=20 return the patient to the sending facility. Alternatively, the mental = health=20 facility may initiate a petition for involuntary treatment to a = facility with=20 greater security. All costs involved in the transportation shall be = billed to=20 the correctional facility.=20
   (3)  In the event the receiving mental = health=20 facility is able to accept the person and a treatment plan is agreed = upon with=20 the person, treatment shall begin immediately.=20
   (4)  The receiving mental health = facility shall=20 notify the person=92s county of residence, if different from the = county where=20 person was charged or sentenced, of the person=92s voluntary = admission. The=20 county administrator is the person to whom the notification is to be = sent.=20
(n)  The treatment plan shall include a written = agreement=20 with the patient that, upon notice to withdraw from treatment, he may = be held=20 at the facility for a reasonable time until arrangements can be made = for=20 transportation by the county jail or State correctional institution.=20
   (1)  In the event the person gives = notice to=20 withdraw and it appears that the standards for involuntary treatment = can be=20 met, proceedings may be initiated under sections 302 and 304 of the = act (50 P.=20 S. =A7 =A7  7302 or 7304).=20
     (i)   During the = pendency of=20 any petitions filed under section 304 of the act, the mental health = facility=20 shall have the authority to detain the person regardless of the = provision of=20 section 203 of the act, provided that the hearing under section 304 of = the=20 act, is conducted within 7 days of the time the person gives notice of = his=20 intent to withdraw from treatment.=20
     (ii)   If no hearing = is held=20 within 7 days subsequent to the filing of a petition under section 304 = of the=20 act, the person shall be returned to, and by the correctional = institution=20 where he was originally detained.=20
(o)  A report of the person=92s mental condition = shall be=20 made by the mental health facility to the court within 30 days of the = person=92s=20 transfer to the facility. The report shall set forth the specific = grounds as=20 to why continued treatment at a mental health facility is necessary. = After the=20 initial report the mental health facility shall thereafter report to = the court=20 every 180 days.=20
   (1)  Copies of the report to the court = shall be=20 sent to the county administrator of the county of residence if = different from=20 the county where the person was charged or sentenced.=20
(p)  At any time when the mental health facility = finds that=20 continued voluntary treatment is no longer necessary the person shall = be=20 discharged and returned to the correctional facility.=20
(q)  Transporting the person to and from the county = jail or=20 State correctional institution for admission or discharge to or from a = mental=20 health facility shall be the responsibility of the county jail or = State=20 correctional institution where the person was originally detained.=20
(r)  Liability for treatment of an individual = admitted to a=20 State mental health facility shall be assessed pursuant to section 505 = of the=20 Mental Health/Mental Retardation Act of 1966 (50 P. S. = =A7  4505), and=20 section 408 of the act (50 P. S. =A7  7408).=20
(s)  Voluntary admission proceedings shall not be = used for=20 the purpose of conducting an inpatient evaluation or for a period of=20 observation in connection with any proceedings with reference to a = criminal=20 act.=20
(t)  Voluntary admission to a facility of a person = charged=20 with crime or undergoing sentence shall be in accordance with Forms = MH-781-X=20 in Appendix A and Forms MH-781-Y and MH-781-Z.=20
(u)  Unauthorized absence from a mental health = facility=20 while under voluntary status.=20
   (1)  For those patients who have = escaped from a=20 hospital who were admitted on a voluntary status under this section no = discharge is to be effected without the following specific actions = being=20 taken:=20
     (i)   As soon as it = has been=20 determined that a patient has left the hospital without authorization, = at=20 least the following are to be notified:=20 =
       (A)   Local = and=20 State police. The police authorities are to be advised that even = though the=20 patient was on a voluntary basis, the subject is to be apprehended and = returned to the hospital since the escaped patient was admitted from a = county=20 jail or State correctional institution while awaiting trial on pending = charges=20 or while serving a sentence.=20 =
       (B)   Respons= ible=20 person.=20
       (C)   The=20 institution or agency having authority over the criminal status, such = as,=20 correctional institution, county jail, probation or parole = departments, and=20 the like.=20
       (D)   The = court=20 and district attorney=92s office of the county with criminal = jurisdiction, and=20 the like, where criminal charges are pending or where sentence was = imposed.=20
       (E)   The = county=20 administrator of the county of residence, if different from the county = where=20 the person was charged or sentenced.=20
       (F)   The = Office=20 of Interstate Services and Records Unit of the Office of Mental = Health.=20
     (ii)   In the event = that the=20 patient has escaped and does not return or is not returned by others = after 72=20 hours, the penal institution or agency from which the person was = admitted on a=20 voluntary status is to be notified right away that the hospital is = discharging=20 the subject from the rolls, and the authority over the case is being=20 officially returned to the agency or institution. In the notification = of the=20 discharge, the hospital should:=20 =
       (A)   Advise = the=20 receiving institution or agency that the subject=92s mental status has = not been=20 known during the period of escape and that following apprehension new=20 commitment procedures would have to be initiated pursuant to the = provisions of=20 the act should the individual appear to require hospitalization.=20
       (B)   Send = notices=20 relating to the discharge and transfer of authority to those listed in = subsection (u)(1)(i)(A)=97(F).=20
     (iii)   All notices = relating=20 to the discharge and turning the case back to the penal authorities = are to be=20 sent by certified mail, return receipt requested.=20
     (iv)   If the patient = is=20 returned to the hospital from escape status prior to discharge:=20
       (A)   The = hospital=20 is to notify all concerned in subsection (u)(1)(i)(A)=97(F).=20
       (B)   The = patient=20 is to be evaluated to determine:=20 =
         (I)  &= nbsp;Whether=20 the patient should continue on voluntary status.=20 =
         (II)  = Whether=20 procedures for involuntary commitment pursuant to the act would be=20 appropriate.=20 =
         (III)  = ; Whether=20 the person should be returned to the penal institution.=20 =
         (IV)  = Under=20 any of these options, the mental health facility is to be certain to = keep the=20 parties listed in subsection (u)(1)(i)(A)=97(F) advised.=20 =
         (V)  &= nbsp;In=20 the event the hospital elects to have the person returned to the penal = institution, that institution is to be advised of the number of days = the=20 person was on unauthorized absence. =
=A7 5100.93. Costs of = treatment.

(a)  The Commonwealth will pay for costs, payments, = or=20 expenditures in excess of $120 per day which are made on behalf of any = person=20 who is a resident of a county located within this Commonwealth and who = receives treatment and for whom liability is imposed on a county = pursuant to=20 section 505(a) of the Mental Health and Mental Retardation Act of 1966 = (50 P.=20 S. =A7  4505(a)).=20
(b)  The county of residence shall be liable for = all costs,=20 payments, or expenditures, up to and including $120 per day, which are = made on=20 behalf of any person who receives treatment and for whom liability is = imposed=20 under section 505(a) of the Mental Health/Mental Retardation Act of = 1966.=20
(c)  The county of sentence shall be liable for all = costs,=20 payments, or expenditures which are made on behalf of any person who = receives=20 observation or examination and for whom liability is imposed under = section=20 505(b) of the Mental Health/Mental Retardation Act of 1966 (50 P. S.=20 =A7  4505(b)).=20
(d)  In the event a residency cannot be determined = to be in=20 a county within this Commonwealth by the court that convicted or = sentenced the=20 person, all liability for treatment shall be the responsibility of the = Commonwealth.=20
(e)  For the purposes of determining liability, the = county=20 wherein in the person had a legal residence prior to being committed = or=20 admitted for treatment will be considered the county of residence. The = determination of a person=92s county of residence for purposes of this = section=20 shall be made by the courts that convicted or sentenced the person.=20
(f)  All patients for whom liability can be imposed = under=20 section 505(a) of the Mental Health and Mental Retardation Act of 1966 = (50 P.=20 S. =A7  4505(a)), and who receive treatment or examination = subsequent=20 to January 24, 1979 are subject to the provisions of subsections = (a)=97(d).=20

No part of the information on this site may be = reproduced for=20 profit or sold for profit.

This material has been drawn = directly from=20 the official Pennsylvania Code full text database. Due to the = limitations of=20 HTML or differences in display capabilities of different browsers, = this=20 version may differ slightly from the official printed version.=20

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CHAPTER 5100. MENTAL HEALTH PROCEDURES

GENERAL PROVISIONS

TREATMENT

MENTAL HEALTH REVIEW OFFICER AND=20 PROCEEDINGS

CONFIDENTIALITY OF MENTAL HEALTH=20 RECORDS

FORMS

PATIENT = RIGHTS

CONTINUITY OF = CARE

VOLUNTARY=20 TREATMENT

INVOLUNTARY=20 TREATMENT

PERSONS CHARGED WITH A CRIME OR UNDER=20 SENTENCE

GENERAL PROVISIONS

=A7 5100.1. Legal base.

TREATMENT

=A7 5100.11. Adequate = treatment.

MENTAL HEALTH REVIEW OFFICER AND = PROCEEDINGS

=A7 5100.21. Proceedings.

=A7 5100.23. Written application, = petitions,=20 statements and certifications.

CONFIDENTIALITY OF MENTAL HEALTH RECORDS

=A7 5100.31. Scope and = policy.

=A7 5100.35. Release to = courts.

=A7 5100.36. Departmental access = to records=20 and data collection.

=A7 5100.39. Release of = records.

FORMS

=A7 5100.41. Forms.

PATIENT RIGHTS

=A7 5100.51. Preservation of = rights.

=A7 5100.52. Statement of = principle.

BILL OF RIGHTS

YOU HAVE A RIGHT TO BE TREATED WITH DIGNITY=20 ANDRESPECT

YOU SHALL RETAIN ALL CIVIL RIGHTS THAT HAVE NOT = BEENSPECIFICALLY=20 CURTAILED BY ORDER OF COURT

Statement of Principle

Statement of Principle

Statement of Principle

Statement of Principle

Statement of Principle

ARTICLE ITHE RIGHT TO=20 COMMUNICATE

ARTICLE IITHE RIGHT TO=20 RELIGIOUSFREEDOM

ARTICLE IIITHE RIGHT TO HANDLEYOUR PERSONAL=20 AFFAIRS

ARTICLE IVRIGHT TO A HUMANE PHYSICALAND PSYCHOLOGICAL=20 ENVIRONMENT

ARTICLE VRIGHT TO = TREATMENT

ARTICLE VIPERMISSIBLE SPECIALIZED ANDPROHIBITED = TREATMENT=20 PROCEDURES

ARTICLE VIIGRIEVANCE AND=20 APPEALPROCEDURES

=A7 5100.56. Existing = regulations.

CONTINUITY OF CARE

=A7 5100.61. Continuity of = care.

VOLUNTARY TREATMENT

=A7 5100.71. Voluntary = examination and=20 treatment.

INVOLUNTARY TREATMENT

=A7 5100.81. Involuntary = examination and=20 treatment.

=A7 5100.82. Jurisdiction and = venue of legal=20 proceedings.

=A7 5100.84. Persons who may be = subject to=20 involuntary emergency examination and treatment.

PERSONS CHARGED WITH A CRIME OR UNDER = SENTENCE

=A7 5100.91. General.

=A7 5100.93. Costs of = treatment.

YOU HAVE A RIGHT TO BE TREATED WITH DIGNITY=20 AND
RESPECT

YOU SHALL RETAIN ALL CIVIL RIGHTS THAT HAVE NOT = BEEN
SPECIFICALLY=20 CURTAILED BY ORDER OF COURT

ARTICLE I
THE RIGHT TO=20 COMMUNICATE

ARTICLE II
THE RIGHT TO=20 RELIGIOUS
FREEDOM

ARTICLE III
THE RIGHT TO HANDLE
YOUR PERSONAL=20 AFFAIRS

ARTICLE IV
RIGHT TO A HUMANE PHYSICAL
AND PSYCHOLOGICAL=20 ENVIRONMENT

ARTICLE V
RIGHT TO = TREATMENT

ARTICLE VI
PERMISSIBLE SPECIALIZED AND
PROHIBITED = TREATMENT=20 PROCEDURES

ARTICLE VII
GRIEVANCE AND=20 APPEAL
PROCEDURES