FORM 1013 – CERTIFICATE AUTHORIZING …

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Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD) Identification form 1013 CERTIFICATE AUTHORIZING transport TO emergency RECEIVING FACILITY & REPORT of TRANSPORTATION (Mental Health) ________________________________________ ________________________________________ ___________________ form 1013 CERTIFICATE AUTHORIZING transport to emergency Receiving Facility & Report of Transportation Mental Health DBHDD By Authority of 37-3-41, 37-3-42 & 37-3 -101 - form Last Revised ; Effective Page 1 of 2 STATE OF GEORGIA, COUNTY OF___________________________ DATE ________________ This is to certify that I have personally examined ________________________________________ _________ on _________________________, 20____

Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD) Identification FORM 1013 – CERTIFICATE AUTHORIZING TRANSPORT TO EMERGENCY RECEIVING FACILITY &

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