Tex. Health & Safety Code § 573.002
(b) The notification of emergency detention must contain:
(d) The peace officer shall provide the notification of emergency detention in substantially the following form:
Notification--Emergency Detention NO. ____________________ DATE:_______________ TIME:_______________
THE STATE OF TEXAS
FOR THE BEST INTEREST AND PROTECTION OF:
______________________________________
DOB:_____________ RACE:______________ GENDER:_______________ PHONE NUMBER:______________ ADDRESS:________________________
Now comes _____________________________, a peace officer with (name of agency) _____________________________, of the State of Texas, and states as follows:
□ I have reason to believe and do believe that (name of person to be detained) __________________________ evidences mental illness;
□ I have reason to believe and do believe that the above-named person evidences a substantial risk of serious harm to himself/herself or others based on the person's behavior or evidence the person is experiencing severe emotional distress and deterioration to the extent the person cannot remain at liberty; and
□ I have reason to believe and do believe that the risk of harm is imminent unless the above-named person is immediately restrained.
1. My above-stated beliefs are based upon the following recent behavior, severe emotional distress and deterioration, overt acts, attempts, statements, or threats observed by me or reliably reported to me (may use attachments to report additional information):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. The names, addresses, phone numbers, and relationship to the above-named person of those persons who reported or observed recent behavior, acts, attempts, statements, or threats of the above-named person are (if applicable):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ADULT 65 YEARS OF AGE OR OLDER? □ YES □ NO If yes, age: ___________
CHILD 17 YEARS OF AGE OR YOUNGER? □ YES □ NO If yes, age: ___________
FOR A CHILD 17 YEARS OF AGE OR YOUNGER (if yes):
My belief the child is at risk of imminent serious harm unless immediately removed from the parents' custody is based on the above-stated facts showing the parents or guardians are presently unable to protect the child from imminent serious harm.
□ I provided notice to the child's parents or guardians of my intention to file this notification.
□ I was not able to provide notice to the child's parents or guardians of my intention to file this notification because: ________________________________________________________________
________________________________________________________________
Parent/Guardian Contact Information: ____________________________
________________________________________________________________
USE OF RESTRAINT
Was the person physically restrained in any way? Yes □ No □
If yes, reason for physical restraint? □ Officer Safety
□ Person's Safety □ Other ____________________
CALL ORIGINATED AT:
□ Public Area □ Residence □ School/University
□ Group Home □ Hospital
□ Other________________________________________
OBSERVATIONS/HISTORY
If YES to any question below, provide additional information:
TRANSPORTED TO:
□ Hospital/Emergency Room □ Mental Health Facility
□ Other _______________________
For the above reasons, I present this notification to seek temporary admission to the (name of facility) _________________________ inpatient mental health facility or hospital facility for the detention of (name of person to be detained) __________________________ on an emergency basis.
PEACE OFFICER'S PRINTED NAME: ___________________________________
BADGE NO. _____________________
PEACE OFFICER'S SIGNATURE _______________________________________
Address: _________________________ Zip Code: ____________________
Telephone: ______________________
SIGNATURE OF EMERGENCY MEDICAL SERVICES PERSONNEL (if applicable)
_________________________ PRINTED NAME OF PERSONNEL: _____________
Address: _________________________ Zip Code: ____________________
Telephone: ______________________
A mental health facility or hospital emergency department may not require a peace officer or emergency medical services personnel to execute any form other than this form as a predicate to accepting for temporary admission a person detained by a peace officer under Section 573.001, Health and Safety Code.
(f) A peace officer who transports an apprehended person to a facility under Section 573.001(d)(1) or emergency medical services personnel of an emergency medical services provider who transports a person to a facility under Section 573.001(d)(2):
(2) may leave the facility immediately after:
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1, 1991.
Acts 2013, 83rd Leg., R.S., Ch. 318 (H.B. 1738), Sec. 2, eff. September 1, 2013.
Acts 2017, 85th Leg., R.S., Ch. 541 (S.B. 344), Sec. 3, eff. June 9, 2017.
Acts 2025, 89th Leg., R.S., Ch. 800 (S.B. 1164), Sec. 2, eff. September 1, 2025.
Acts 2025, 89th Leg., R.S., Ch. 800 (S.B. 1164), Sec. 3, eff. September 1, 2025.