Vermont Second Certificate by a Psychiatrist

After a person is admitted on an emergency examination in Vermont under 18 V.S.A. section 7508, a psychiatrist at the designated hospital examines the patient and completes this second certificate. It states whether the patient is a person in need of treatment, which determines whether the involuntary hold continues, and it supports any later application for involuntary treatment.

Who completes it

A psychiatrist completes the whole form, basing the opinion on their own examination plus review of the first certifying physician's assessment and the application for emergency examination.

Submitting and payment

How to submit it
A copy is faxed or securely emailed to the VPCH Admissions Office, and the original stays in the hospital record.

Good to know

  • The exam can be in person or by telemedicine; Section I records which, along with the patient's current hospital location from a checklist.
  • Section II is a checkbox mental status exam covering consciousness, orientation, speech, thought process, perception, insight, judgment and suicidal or homicidal ideation.
  • Later sections ask for evidence of dangerous behavior, its link to mental illness, less restrictive alternatives, whether the patient is voluntary, and a DSM-5 diagnosis.
  • The current version was revised 2026-03-18 and is also posted as a Word file; a separate Request for Second Certification by a Psychiatrist form exists.

Get the official form

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

Second Certificate by a Psychiatrist for Emergency Exam

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

Can Vermont's second certification be done by telemedicine?

Yes. Section I of the Second Certificate by a Psychiatrist has checkboxes for an in-person examination or a telemedicine examination, and the psychiatrist records the patient's current location from a list of Vermont hospitals or enters another location.

What does the psychiatrist certify on the second certificate?

That they examined the patient that day and that, in their opinion, the patient is or is not a person in need of treatment, based on their own exam and review of the first physician's paperwork and the emergency exam application. The statements are made under the pains and penalties of perjury.