Florida receiving and treatment facilities use this certification to document whether a person can give express and informed consent to voluntary admission and to treatment. The examiner chooses one of three findings: competent to consent to both, incompetent (requiring transfer to involuntary status and a guardian advocate petition), or refusing voluntary admission but competent to consent to treatment.
A physician or psychiatric nurse who personally examined the person completes and signs it, with license number, date and time. It notes whether the person is an adult without a guardian or surrogate, or a minor whose parent or guardian applies.
Download the current version from the source each time; forms change without notice.
Certification of Individual's Competence to Provide Express and Informed Consent
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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Within 24 hours of the individual's arrival at the receiving facility. It must be in the clinical record for anyone admitted voluntarily, permitted to consent to their own treatment, or transferred from involuntary to voluntary status, and before restoring consent rights after an incompetence finding.
A physician or psychiatric nurse. The signer certifies having personally examined the individual at the facility and records the date and time of the exam, their printed name and license number.
The form states that a person incompetent to consent to voluntary admission is also incompetent to consent to treatment, must be transferred to involuntary status, and needs a petition for a guardian advocate filed with the circuit court.