Under Florida's Marchman Act, a qualified professional uses this certificate to state that they examined a person, found them substance use impaired or with a co-occurring disorder, and found them appropriate for emergency admission. It documents loss of self-control, likely harm or neglect, or impaired judgment preventing voluntary care, and recommends a level of care.
A licensed psychiatrist, physician, clinical psychologist, psychiatric nurse, clinical social worker, mental health counselor, marriage and family therapist, physician assistant or APRN, or a master's-level certified addictions professional, completes and signs it.
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Certificate of Professional for Emergency Assessment for Substance Abuse Services
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CF-MH 4057 states that the professional certificate is valid for seven days after issuance. The examination time recorded on it must be within the preceding 48 hours, and every section must be completed legibly.
A licensed psychiatrist, physician, clinical psychologist, psychiatric nurse, clinical social worker, mental health counselor, marriage and family therapist, physician assistant or advanced practice registered nurse, or a master's-level certified addictions professional. The signer also states their relationship to the individual and the applicant.
That the person is substance use impaired or has a co-occurring disorder and has lost self-control over substance use, plus either likely neglect or physical harm without care, or refusal of care caused by impaired judgment that prevents recognizing the need for treatment.