1. (a) The administrator of behavioral health or designee initiating a transfer to the SPU of a resident shall supply the following on the “Transfer of a Person Under Departmental Control to the Secure Psychiatric Unit for Behavioral Health Treatment Services Pursuant to RSA 623:1” form:

   1. (1) The name of the resident;
   2. (2) Correctional facility name;
   3. (3) Address; and
   4. (4) His or her name and title.

2. (b) The transfer form shall contain a notice to the resident that includes:

   1. (1) A statement that he or she is being considered for transfer to the SPU pursuant to RSA 623: 1 for the purpose of receiving behavioral health treatment;
   2. (2) A list of the criteria for admission to the SPU for behavioral health treatment services pursuant to RSA 623:1;
   3. (3) Definitions of the terms “behavioral health illness” and “harm to himself, herself, or others” for the provider’s certification; and
   4. (4) A statement that he or she has due process rights, which include the opportunity for a hearing.

3. (c) The licensed provider who examines the resident shall supply the following on the transfer form:

   1. (1) His or her name and title;
   2. (2) The name of the resident recommended for transfer; and
   3. (3) The date on which he or she personally examined the resident.

4. (d) The licensed provider shall then:

   1. (1) Sign and date the form; and
   2. (2) Certify by his or her signature that in his or her opinion the criteria for transferring the resident to the SPU have been met.
5. (e) A resident who agrees to be transferred to the SPU shall sign and date a waiver of his or her right to a hearing.
6. (f) A resident who objects to being transferred to the SPU shall sign and date page 3 of the “Transfer of a Person Under Departmental Control to the Secure Psychiatric Unit for Behavioral Health Treatment Services Pursuant to RSA 623:1” form to request a hearing.

Source. (See Revision Note at chapter heading for Cor 500) #12793, eff 5-25-19