New York OMH 476: CPEP Emergency Admission (9.40)

Comprehensive Psychiatric Emergency Programs (CPEPs) in New York record involuntary emergency admissions under Mental Hygiene Law section 9.40 on OMH 476. A clinician meets it when working in an OMH-licensed CPEP and a person arrives with a mental illness likely to result in serious harm. The form documents the admitting physician's findings and, for stays beyond 24 hours, a staff psychiatrist's confirmation and move to an extended observation bed.

Who completes it

A CPEP staff physician completes Section II, the record of admission, after examining the person. A different physician on the CPEP's psychiatric staff completes Section III and the Section IV staff psychiatrist's confirmation within 24 hours of arrival in the CPEP emergency room.

Submitting and payment

How to submit it
The form stays in the CPEP record. The patient receives written notice of status and rights, which also goes to the Mental Hygiene Legal Service and up to three people the patient designates; it may be completed in the EHR.

Good to know

  • The staff physician must examine the person as soon as practicable and no later than six hours after arrival in the CPEP emergency room.
  • No patient may stay in the CPEP more than 24 hours without the psychiatrist's confirmation and a move to an extended observation bed.
  • Within 72 hours the person is discharged, admitted voluntarily, or evaluated for admission to a section 9.39 hospital (OMH 474) or under section 9.27.
  • Only CPEPs licensed by the Office of Mental Health to provide psychiatric emergency services can admit under section 9.40; the current edition is OMH Form 476 (3/2026).

Get the official form

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

CPEP Emergency Admission (Mental Hygiene Law §9.40)

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 soon must a CPEP patient be examined on the OMH 476?

A CPEP staff physician must examine the person as soon as practicable and no later than six hours after they are received in the CPEP emergency room. A psychiatrist's confirmation is then required within 24 hours for the person to stay longer in an extended observation bed.

What happens after 72 hours in a CPEP?

The person is discharged unless they agree to voluntary or informal admission. If they are likely to keep meeting the standard, they are evaluated for admission to a section 9.39 hospital; if they need inpatient care but no longer meet the emergency standard, section 9.27 applies.