Colorado M-12: Notice of Short-Term Certification

After evaluation at a designated provider in Colorado, a professional person uses this notice to certify a respondent for short-term treatment for up to three months under C.R.S. 27-65-109. It states, by clear and convincing evidence, that the respondent has a mental health disorder and is a danger to others, a danger to self, or gravely disabled, and whether the disorder is persistent.

Who completes it

The professional person completes and signs the certification with a Colorado license number, attaching a statement of facts from a staff professional who evaluated the respondent. The respondent signs a receipt, or staff record personal delivery and mailing.

Submitting and payment

How to submit it
Deliver a copy personally to the respondent, mail copies to the respondent's attorney, any designated lay person and any guardian, and file the original with the court within 48 hours, excluding weekends and court holidays.

Good to know

  • The notice must state that voluntary treatment was offered and refused, or accepted with reasonable grounds to believe the respondent will not remain in it.
  • The form has boxes recommending inpatient or outpatient certification. Extensions use the Notice of Extended Short-term Certification (M-23).
  • If an attorney has not already been appointed, Form M-3 must accompany the certification submitted to the court.
  • Distribution covers the court, respondent, county or district attorney, respondent's records and attorney, and the Behavioral Health Administration. Current edition Rev. 07/2026.

Get the official form

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

Notice of Short-term Certification

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

How long does a Colorado short-term certification last?

Up to three months from the date of the notice. The respondent may ask at any time, in writing, for court or jury review of the certification or for outpatient treatment, and has the right to an attorney.

When must the M-12 be filed with the court?

Within 48 hours of the date of certification, excluding Saturdays, Sundays and court holidays. It is filed in the court of the county where the respondent lived or was physically present just before being taken into custody, showing proper delivery and mailing.

What if the respondent will not sign the M-12 receipt?

Give the respondent a copy anyway, and the person who handed it over completes the acknowledgment of service with the date. If the respondent does not designate a lay person to receive a copy, write 'Respondent Declined' on that line of the certificate of mailing.