When a New York county Director of Community Services (DCS) or a designated examining physician starts an involuntary admission under Mental Hygiene Law section 9.37, the OMH 475 packet is used. A clinician meets it on a mobile crisis or county team acting as a DCS designee, or as a hospital physician examining the person on arrival and over the first 72 hours. The packet includes the application and four certificate or examination forms.
The DCS or designee completes the OMH 475 application and either the 475A physician certificate or, in limited cases, the 475B certificate of observation. A hospital staff physician confirms the need before admission, another completes the 475C within 24 hours after a 475B admission, and a staff psychiatrist completes the 475D.
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Application for Involuntary Admission on Certificate of a Director of Community Services or Designee
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The 475A is the certificate of examination by a DCS or physician designee. The 475B is a certificate of observation that a non-physician DCS can use only in small counties when no section 9.39 hospital is within 30 miles and no designated physician is available; it then needs a 24-hour confirmation (475C).
Hospital staff. The 475C is a staff physician's examination within 24 hours after admission on a 475B certificate of observation. The 475D is the staff psychiatrist's examination required before the patient can be retained beyond 72 hours, excluding Sundays and holidays.