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Baker Act

Baker Act Forms

The links on this page all require the use of the Adobe Reader which is free from the Adobe.com web site or Microsoft Word which can be viewed using Office Online if needed.

IMPORTANT: Mandatory Forms may NOT be altered.

Recommended forms are those which are not required by the department, but which have been determined to satisfy the specific requirements for which the form was developed. Alterations of recommended forms may jeopardize this status.

Baker Act Forms - Mandatory
(IMPORTANT: Mandatory Forms may NOT be altered.)

Baker Act Forms (Recommended)

Recommended forms are those which are not required by the department, but which have been determined to satisfy the specific requirements for which the form was developed. Alterations of recommended forms may jeopardize this status.

Files
Access Confidentiality and Nondisclosure Agreement
CF MH 3001 Jul. 2020 Ex Parte Order for Involuntary Examination Spanish
CF MH 3001 Jul. 2020 Ex Parte Order for Involuntary Examination
CF MH 3002 Jul. 2020 Petition and Affidavit Seeking Ex Parte Order Requiring Involuntary Examination Spanish
CF MH 3002 Jul. 2020 Petition and Affidavit Seeking Ex Parte Order Requiring Involuntary Examination
CF MH 3008 Feb. 2005 Order for Involuntary Inpatient Placement
CF MH 3021 Feb. 2005 Notice of Petition for Involuntary Placement
CF MH 3022 Feb. 2005 Application for Appointment of Independent Expert Examiner Spanish
CF MH 3022 Feb. 2005 Application for Appointment of Independent Expert Examiner
CF MH 3024 Feb. 2005 Notice of Petition for Continued Involuntary Inpatient Placement
CF MH 3031 Feb. 2005 Order for Continued Involuntary Inpatient Placement or for Release
CF MH 3032 Feb. 2005 Petition for Involuntary Inpatient Placement
CF MH 3033 Feb. 2005 Notification to Court of Withdrawal of Petition for Hearing on Involuntary Inpatient or Involuntary Outpatient Placement
CF MH 3035 Feb. 2005 Petition Requesting Authorization for Continued Involuntary Inpatient Placement
CF MH 3036 Feb. 2005 Notice of Right to Petition for Writ of Habeas Corpus or for Redress of Grievances Spanish
CF MH 3036 Feb. 2005 Notice of Right to Petition for Writ of Habeas Corpus or for Redress of Grievances
CF MH 3038 Feb. 2005 Notice of Release or Discharge
CF MH 3040 Feb. 2005 Application for Voluntary Admission (Receiving Facility) Spanish
CF MH 3040 Feb. 2005 Application for Voluntary Admission (Receiving Facility)
CF MH 3042a Feb. 2005 General Authorization for Treatment Except Psychotropic Medications Spanish
CF MH 3042a Feb. 2005 General Authorization for Treatment Except Psychotropic Medications
CF MH 3042b Feb. 2005 Specific Authorization for Psychotropic Medications Spanish
CF MH 3042b Feb. 2005 Specific Authorization for Psychotropic Medications
CF MH 3043 Feb. 2005 Inventory of Personal Effects Spanish
CF MH 3043 Feb. 2005 Inventory of Personal Effects
CF MH 3044 Feb. 2005 Authorization for Release of Information Spanish
CF MH 3044 Feb. 2005 Authorization for Release of Information
CF MH 3045 Jul. 2020 Notice of Person's Admission for Involuntary Examination
CF MH 3046 Feb. 2005 Application for and Notice of Transfer to Another Facility Spanish
CF MH 3046 Feb. 2005 Application for and Notice of Transfer to Another Facility
CF MH 3048 Feb. 2005 Confidentiality Agreement Spanish
CF MH 3048 Feb. 2005 Confidentiality Agreement
CF MH 3049 Feb. 2005 Restriction of Communication or Visitors Spanish
CF MH 3049 Feb. 2005 Restriction of Communication or Visitors
CF MH 3051a Feb. 2005 Notice of Right of Person on Voluntary Status to Request Discharge From a Receiving Facility Spanish
CF MH 3051a Feb. 2005 Notice of Right of Person on Voluntary Status to Request Discharge From a Receiving Facility
CF MH 3051b Feb. 2005 Notice of Right of Person on Voluntary Status to Request Discharge from a Treatment Facility Spanish
CF MH 3051b Feb. 2005 Notice of Right of Person on Voluntary Status to Request Discharge from a Treatment Facility
CF MH 3057 Feb. 2005 Authorization for Electroconvulsive Treatment Spanish
CF MH 3057 Feb. 2005 Authorization for Electroconvulsive Treatment
CF MH 3089 Feb. 2005: Transfer Evaluation (To a State Mental Health Treatment Facility)CF MH 3089 Feb. 2005: Transfer Evaluation (To a State Mental Health Treatment Facility)
CF MH 3090 Feb. 2005 Petition for Writ of Habeas Corpus or for Redress of Grievances Spanish
CF MH 3090 Feb. 2005 Petition for Writ of Habeas Corpus or for Redress of Grievances
CF MH 3097 Feb. 2005 Application for Voluntary Admission Minors Spanish
CF MH 3097 Feb. 2005 Application for Voluntary Admission Minors
CF MH 3098 Feb. 2005 Application for Voluntary Admission (State Treatment Facility) Spanish
CF MH 3098 Feb. 2005 Application for Voluntary Admission (State Treatment Facility)
CF MH 3099 Feb. 2005 Certification of Ability to Provide Express and Informed Consent For Voluntary Admission and Treatment of Selected Persons From Facilities Licensed Under Chapter 400, F.S.
CF MH 3101 Jul. 2020 Hospital Determination That Person Does Not Meet Involuntary Placement Criteria
CF MH 3102 Jul. 2020 Request for Involuntary Examination After Stabilization of Emergency Medical Condition
CF MH 3103 Feb. 2005 Rights of Persons in Mental Health Facilities and Programs
CF MH 3104 Feb. 2005 Certification of Person's Competence to Provide Express and Informed Consent
CF MH 3105 Feb. 2005 Refusal or Revocation of Consent to Treatment Spanish
CF MH 3105 Feb. 2005 Refusal or Revocation of Consent to Treatment
CF MH 3106 Feb. 2005 Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate
CF MH 3107 Feb. 2005 Order Appointing Guardian Advocate
CF MH 3108 Feb. 2005 Petition Requesting Court Approval for Guardian Advocate to Consent to Extraordinary Treatment
CF MH 3109 Feb. 2005 Order Authorizing Guardian Advocate to Consent to Extraordinary Treatment
CF MH 3110 Feb. 2005 Restriction of Person's Access to Own Record Spanish
CF MH 3110 Feb. 2005 Restriction of Person's Access to Own Record
CF MH 3111 Feb. 2005 Approval for Release of Person on Involuntary Status from a Receiving Facility
CF MH 3113 Feb. 2005 Notice to Court Request for Continuance of Involuntary Placement Hearing
CF MH 3114 Feb. 2005 Order Requiring Involuntary Assessment and Stabilization for Substance Abuse and for Baker Act Discharge of Person
CF MH 3115 Feb. 2005 Order Requiring Evaluation for Involuntary Outpatient Placement
CF MH 3116 Feb.2005 Findings and Recommended Order Restoring Person's Competence to Consent to Treatment and Discharging the Guardian Advocate
CF MH 3119 Jul. 2020 Notification of a Facility's Non Compliance (Pursuant to Chapter 400, F.S.)
CF MH 3120 Feb. 2005 Certification of Guardian Advocate Training Completion
CF MH 3121 Feb. 2005 Notification to Court of Person's Competence to Consent to Treatment and Discharge of Guardian Advocate Spanish
CF MH 3121 Feb. 2005 Notification to Court of Person's Competence to Consent to Treatment and Discharge of Guardian Advocate
CF MH 3122 Feb. 2005 Certification of Person's Incompetence to Consent to Treatment and Notification of Health Care SurrogateProxy Spanish
CF MH 3122 Feb. 2005 Certification of Person's Incompetence to Consent to Treatment and Notification of Health Care SurrogateProxy
CF MH 3123 Feb. 2005 Affidavit of Health Care Proxy Spanish
CF MH 3123 Feb. 2005 Affidavit of Health Care Proxy
CF MH 3124 Feb. 2005 Personal Safety Plan Spanish
CF MH 3124 Feb. 2005 Personal Safety Plan
CF MH 3130 Feb. 2005 Petition for Involuntary Outpatient Placement
CF MH 3140 Sept. 2006 Designation of Service Provider for Involuntary Outpatient Placement
CF MH 3145 Sept. 2006 Proposed Individualized Treatment Plan for Involuntary Outpatient Placement and Continued Involuntary Outpatient Placement Spanish
CF MH 3145 Sept. 2006 Proposed Individualized Treatment Plan for Involuntary Outpatient Placement and Continued Involuntary Outpatient Placement
CF MH 3150 Feb. 2005 Notice to DCF of non filing of Petition of Involuntary Outpatient Placement or Diminished Treatment Plan
CF MH 3155 Feb. 2005 Order for Involuntary Outpatient Placement or Continued Involuntary Outpatient Placement
CF MH 3160 Feb. 2005 Notice to Court of Modification to Treatment Plan for Involuntary Outpatient Commitment andor Request for Approval of Material Modifications to Plan Spanish
CF MH 3160 Feb. 2005 Notice to Court of Modification to Treatment Plan for Involuntary Outpatient Commitment andor Request for Approval of Material Modifications to Plan
CF MH 3170 Feb. 2005 Petition for Termination of Involuntary Outpatient Placement Order Spanish
CF MH 3170 Feb. 2005 Petition for Termination of Involuntary Outpatient Placement Order
CF MH 3180 Feb. 2005 Petition Requesting Authorization for Continued Involuntary Outpatient Placement
CF MH 3185 Feb. 2005 Notice to Court of Waiver of Continued Involuntary Outpatient Placement Hearing and Request for an Order
CF MH 7000 Jan. 1998 State Mental Health Facility Admission Form
CF MH 7001 Jan. 1998 State Mental Health Facility Discharge Form
CF MH 7002 Feb. 2005 7002 Physician to Physician Transfer
DCF Poster i155 Your Rights While Receiving Mental Health Services
DCF Poster i155 Your Rights While Receiving Mental Health Services (Creole)
DCF Poster i155 Your Rights While Receiving Mental Health Services (Spanish)
Baker Act Forms (Creole)
Application for and Notice of Transfer (Creole)
Application for Appointment of Independent Exper. (Creole)
Application for Voluntary Admission (Creole)
Application for Voluntary Admissions Minors (Creole)
Application for Voluntary Admissions State Treatment (Creole)
Authorization for Electroconvulsive Treatment (Creole)
Authorization for Release of Information (Creole)
Certification of Guardian Advocate Training Comp. (Creole)
De escalation Preference Form (Creole)
Florida Baker Overview (Creole)
General Authorization for Treatment Except Psych. (Creole)
Inventory of Personal Effects (Creole)
Notice of Right to Petition (Creole)
Notice of Voluntary Patients Right to request B (Creole)
Notice of Voluntary Patients Right to request A (Creole)
Notification to Healthcare Surrogate (Creole)
Refusal or Revocation of Consent to Treatment (Creole)
Restrictions of Communications or Visitors (Creole)
Rights of Patients (Creole)
Specific Authorization for Psychotropic Medication (Creole)

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