Frequently used forms:

Prescreening Procedure and Checklist 

             [Print only version]  Fill out electronic or Print version during ECO evaluations

                                               Save in “Daily notes/0-ECO Procedure checklist” Group folder or fax to the VCSB ES Office.

             [Highlights version]  Over-emphasis highlights of Required steps within HPR1 [under age 65] and HPR7 [age 65 and over] admission protocols.


Preadmission Screening Form

             AKA: Prescreening


TDO Petition

             AKA: Petition for Involuntary Treatment


VCSB ES Safety Plan

             Printable version of VCSB ES Safety plan template.

             [Fillable version]


Emergency Services Brief Contact Note

             Copy of this Note or of your CCP Progress Note is to be left for the client’s medical records within the facility where a Crisis Intervention service occurs.


Important, though Rarely used, forms:

Information Sheet for ECO-TDO Respondent

             Provide a copy to clients under Paperless ECO IF Officer did not already do so.


Notice of Alt Facility for TDO

             Use for all changes to the Facility of Temporary Detention.

             Complete and Fax to Clerk of the appropriate court; both facilities and the LEO or Alternative Transportation Provider.


Petition/Order for transportation to Alternative Facility on TDO

             Use in addition to the “Notice of...” above for changes to the Facility of Temporary Detention occurring after the respondent has arrived at the original facility.

             Complete top portion and Fax to Magistrate’s Office for approval.  Fax approved form to all locations noted above along with the “Notice of...”


External links:


Link to all MH forms on the General District Court website.


Link to the Prescreening form on the DBHDS website.

(Note: Their form is not user-friendly, but should always be up to date.)