SOP 508.25-att-3: Emergency Admission Rights of Offenders (Form M65-01-03)

SOP 508.25
Attachment 3

8/2/22

# 1. You will have 24 hours after receiving this notification to decide if you wish to contest the doctor's

recommendation to admit you to the hospital.

# 2. If you decide to contest the decision of the doctor, you have a right to go before a hearing officer

appointed by the Commissioner of the Georgia Department of Corrections. This hearing officer will
hold a full and fair hearing to consider whether or not you meet the criteria for involuntary
admission. If you decide that you want such a hearing, one will be scheduled no earlier than five (5)
days after you receive this notice. The due process hearing committee will be composed of a Deputy
Warden of Care and Treatment, a Psychiatrist or Psychologist, and a medical staff member.

# 3. You have the right to represent yourself at the hearing. If you do not wish to represent yourself at

the hearing, you may request the assistance of an advocate. You may elect to have a mental health
counselor of the Georgia Department of Corrections serve as your advocate. You may also seek
representation from any attorney licensed in Georgia at your expense. Your advocate or
representative may assist you at the hearing.

# 4. You have the right to full disclosure of the evidence against you. 5. You or your advocate have the right to present any relevant evidence to the hearing officer. 6. You have the right to call witnesses on your behalf as long as they are reasonably available unless

good cause exists not to allow. The hearing officer can decide to take their testimony by telephone
or in writing.

# 7. You have the right to question or cross-examine witnesses called at the hearing by the Georgia

Department of Corrections. The hearing officer, however, has the discretion to properly deny your
request to confront and cross-examine particular witnesses if the hearing officer believes that good
cause exists not to allow.

# 8. You have the right not to have a hearing and to proceed with the psychiatric treatment that has been

recommended for you.

Form no. M65-01-03 Page 1 of 2

Retention Schedule: Completed forms will be given to the Psychiatric Hospital (original), a copy will be given to the
offender, placed in the offender’s mental health file (section 5) and medical file (section 5). At the end of the offender’s
need for mental health services and/or sentence, the mental health file will be placed within the offender’s health record
and retained for 10 years.

SOP 508.25
Attachment 3

8/2/22

Acknowledgement of Notification

(Initial and circle any items which apply.)

# A. I do hereby state that I have read or have had explained to me the decision of the need for

hospitalization in my case.

# B. I do hereby also state that I have read or have had explained to me all of my rights to a hearing to

contest the recommendation that I be admitted to a mental hospital for the purpose of receiving
psychiatric care and treatment.

# C. I (do) (do not) want to exercise my right to a fair and impartial hearing in my case. D. I (do) (do not) want an expedited hearing. E. I (do) (do not) elect to have a mental health counselor with the Georgia Department of Corrections

serve as my Advocate.

# F. I (do) (do not) elect to retain a private attorney at my own expense. G. My decision not to exercise my right to a fair and impartial hearing is made voluntarily, without

threat or any other improper promises or inducements, and with full knowledge of its meaning and
effect. I further understand that the reason for my admission is to receive psychiatric treatment.

_______________________________________
Signature of Counselor

_______________________________________
Offender's Signature and GDC I.D. Number

_______________________________________
Signature of Witness/Title

_________________ ____________________
Date Time

Form no. M65-01-03 Page 2 of 2

Retention Schedule: Completed forms will be given to the Psychiatric Hospital (original), a copy will be given to the
offender, placed in the offender’s mental health file (section 5) and medical file (section 5). At the end of the offender’s
need for mental health services and/or sentence, the mental health file will be placed within the offender’s health record
and retained for 10 years.