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MARVIN MANDEL, Governor 3109
PHYSICIANS CERTIFICATE TO ACCOMPANY
APPLICATION FOR INVOLUNTARY ADMISSION
Patient's Name.......................................
At the time of my examination, the above named
patient showed the following symptoms:
Physical (Illness, Injury, Deformity)............
Mental (History and Mental Status)__...................
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I hereby certify that on........, 19......., I, a
graduate of................ Medical College and licensed
to practice in the State of Maryland, personally examined
the above named patient and believe that he has a mental
disorder and that the disorder is of a character which,
in my opinion, requires that the patient be placed in a
facility for the treatment of the mentally disordered. I
am not related by blood or marriage to the patient, nor
do I have any financial interest in the facility in which
it is proposed to place the patient. I further certify
that this certificate is signed and made within one week
of the examination of the patient.
Signed:..........................Date:.................
(2) No certificate shall be used for
purposes of admission if based on an examination made
more than 30 days prior to receipt of the application for
admission by the facility or the Veterans' Administration
hospital.
(3) No certificate shall be executed by any
physician financially interested, by reason of ownership
or salary, in any private facility in which it is
proposed to admit the person whose status is being
certified, nor may such physician be related by blood or
marriage to either the prospective patient or the
applicant.
(e) At least once each year, every patient
retained by a facility pursuant to this section shall be
examined and the certificate__required under subsection
(d) above shall be again executed. Such certificates
shall meet all the requirements of subsection (d), and
upon completion, must be reviewed by the superintendent
of the facility and filed with the patient's records.
22.
(a) As used in this subtitle, the following terms
shall have the meanings indicated unless a contrary
meaning is clearly intended from the context in which the
term appears.
(1) "Emergency admissions" shall mean that
process by which an emergency admittee is admitted on an
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