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Utah DSAMH

Civil Commitment Forms - Child

Form Description Statute Updated DE Req?
Application (Involuntary Initial)
Petition for Commitment of Physical Custody of Child to the Local Mental Health Authority
Form 0001
Used to initiate civil commitment proceedings 62 A-15-703 (1)(2) 2012 No
Notice of Proceeding of Child for Commitment of Physical Custody to the Local Mental Health Authority
Form 0003
Notice to child and appropriate others that an application has been filed and a hearing has been set 62A-15-703(5)(b) 2012 No, but often do
Commitment of Physical Custody of Child to Local Mental Health Authority Proceeding (2 pages)
Form 0005
DE (NDFF) report of commitment proceeding 62A-15-703 2012 Yes
Application (Emergency)
Emergency Application for Commitment of Child Without Certification (The Pink Sheet) (2 pages)
Form 0029
Peace officers or mental health officer may use this form to temporarily hold an individual for 72 hours (Two sided. Printed on pink paper.) 62A-15-703(6) and 62A-15-629 (2) 2012 No
Emergency Application for Commitment of Child With Certification (The Blue Sheet) (2 pages)
Form 0031
Allows an individual to be temporarily held for 72 hours. Requires certification by MD or DE (Two sided. Printed on blue paper.) 62A-15-703(6) and 62A-15-629 (1) 2012 Yes, but not required
Commitment (Release)
Notice of Discharge From Commitment to the Local Mental Health Authority of a Child
Form 0067
LMHA uses form to discharge a child from commitment 62A-15-703(13) and 78A-6-120(6) 2012 No