Transcription of FORM 1013 – CERTIFICATE AUTHORIZING TRANSPORT TO …
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Example: dental hygienist
FORM 1013 – CERTIFICATE AUTHORIZING TRANSPORT TO …
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____ at _____m, which was within the preceding 48 hours of the signing of this CERTIFICATE . In my opinion this Individual appears to be a mentally ill person requiring involuntary treatment in that he/she appears to be mentally ill AND: [ ] A.
Certificate Authorizing Transport to Emergency Receiving Facility and Report of Transportation (Mental Health) ~ Effective Date: March 31, 2012
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