Emergency involuntary admission in Tennessee under Title 33, Chapter 6, Part 4 runs on this five-page form. Part 1 authorizes emergency detention for immediate examination, Part 2 is the first certificate of need, and Part 3 the second. A clinician meets it in a crisis evaluation, either detaining the person or certifying, face to face or by telehealth, that they meet four admission criteria.
Part 1 is completed by a law enforcement officer, licensed physician, HSP psychologist or a QMHP designated as a mandatory pre-screening agent, and Part 2 by a designated pre-screening agent, or by a physician or HSP psychologist when none was available within 2 hours and the crisis team was consulted. Part 3 is completed by a licensed physician, or by a qualified advanced practice provider when a physician completed Part 2.
Download the current version from the source each time; forms change without notice.
Certificate of Need for Emergency Admission under Title 33, Chapter 6, Part 4, Tennessee Code Annotated
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
A law enforcement officer authorized to make arrests in Tennessee, a licensed physician, a licensed psychologist with health service provider designation, or a qualified mental health professional designated by the TDMHSAS Commissioner as a mandatory pre-screening agent. The detaining person describes the observed behavior showing risk and records the disposition, such as released, transferred or admitted.
Yes. Parts 2 and 3 each ask the examiner to check whether the certificate is based on a face-to-face or a telehealth examination, and Part 2 can send the person to a TDMHSAS-designated telehealth location for the second certificate of need instead of direct transport to an admitting psychiatric facility.
A licensed physician or HSP psychologist who is not a designated mandatory pre-screening agent can complete Part 2 when no pre-screening agent was available within 2 hours, after consulting the local mental health crisis team about less drastic alternatives. The form asks for the name and agency of the crisis team staff member consulted.