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Maine 24-Hour Certificate: Psychiatric Hospitalization

After a person is admitted to a Maine psychiatric hospital on an emergency Blue Paper (MH-100.A), a second examiner must see them within 24 hours under 34-B M.R.S. section 3863(7). This one-page certificate records that examination: the symptoms of mental illness, the recent behavior showing a likelihood of serious harm, and the opinion that adequate community resources are unavailable. Without it, the patient must be released.

Who completes it

A physician or licensed clinical psychologist who did not certify the patient for the Blue Paper completes, signs and prints their name on the whole form, checking which of the two qualifications applies.

Submitting and payment

How to submit it
The admitting hospital keeps the signed certificate with the patient's Blue Paper. It supports any later application the hospital files with the District Court for an involuntary commitment, known as the White Paper (MH-108).

Good to know

  • Enter the date and time of involuntary admission, which the form defines as when the hospital began holding the patient on the Blue Paper, then the date and time of your own examination.
  • Item 5 asks for recent actions and behaviors under three headings: threats or attempts of suicide or self-harm, violent or threatening conduct toward others, and inability to protect oneself from severe harm.
  • A Blue Paper admission lasts 3 days, not counting the day of admission. To keep the patient longer, the hospital needs a voluntary admission or a White Paper filed with the District Court.
  • DHHS posts it as a Model Form dated September 2015, issued under 34-B M.R.S.A. section 3802(5). It is a flat PDF, printed and completed by hand.

Get the official form

Download the current version from the source each time; forms change without notice.

Certification of Need for Psychiatric Hospitalization ("24-Hour Certificate")

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can sign Maine's 24-Hour Certificate?

A physician or a licensed clinical psychologist who was not the examiner who certified the patient for the Blue Paper. The examiner checks which qualification applies, records when they examined the patient, and certifies that the examination took place within 24 hours after the patient's admission to the psychiatric hospital.

What happens if the 24-hour examination does not support the hold?

If the second examiner does not certify that the patient is mentally ill and, because of that illness, poses a likelihood of serious harm, the hospital must release the person. The patient can still agree to stay as a voluntary patient, which the hospital may offer at any time during the Blue Paper period.

How does the 24-Hour Certificate relate to the Blue Paper and White Paper?

The Blue Paper (MH-100.A) authorizes the emergency admission. The 24-Hour Certificate confirms it with a second, independent examination. If the hospital wants the patient to stay beyond the 3-day Blue Paper period without a voluntary admission, it files a White Paper (MH-108) asking the District Court for a commitment order.