Summary. Eleven working documents, plus the annotations that make them work.

How to use these

Nothing in this toolkit requires a lawyer to prepare, and nothing in it is a substitute for one. The documents here are the ones that most reliably change what happens, and almost all of them fail in the same way: they are prepared too late, or written too vaguely.

Prepare Templates 1 through 4 while the person is well. They take an afternoon. They are the difference between the two families in the companion guide.

Templates 5 through 8 are for the days of a hold. You will have very little time. Having read them once beforehand is most of the value.

Fill the brackets. Delete what does not apply. Date everything. Keep copies.

Template 1 — Psychiatric advance directive

Recognized by statute in most states. Enforceability varies and clinicians may override in emergencies in many jurisdictions — but a directive changes the conversation in the room and tells a treatment team, in an hour, things they would otherwise learn over three weeks of trial and error.

PSYCHIATRIC ADVANCE DIRECTIVE OF [Full name] Date of birth: [ ] · Date executed: [ ]

1. Purpose. I am making this directive while I have capacity, so that my wishes are known if I later do not. I have [diagnosis]. I have been hospitalized [number] times, most recently in [month, year].

2. What helps me. [Be specific and practical. This section gets read.] [Examples: "Being allowed to walk outside with a staff member does more for me than anything else." · "I do better when the lights in my room are off." · "I am much calmer if someone explains what is happening before it happens." · "I have a hearing loss on the left. Please stand on my right."]

3. What makes things worse. [Examples: "Being touched without warning." · "Being told I am not making sense." · "Restraint. I have a trauma history and restraint escalates me severely."]

4. Medications I consent to. [Drug, dose, route.] These have worked for me.

5. Medications I refuse, and why. [Drug — reason. "Haloperidol: akathisia so severe I could not sit down or sleep for four days." A refusal with a clinical reason is respected far more often than a bare refusal.]

6. Allergies and medical conditions. [Including non-psychiatric — diabetes, seizure disorder, anticoagulation, sleep apnea and CPAP.]

7. Electroconvulsive therapy. I [consent / do not consent] to ECT. [Reason.]

8. Hospital preference. I prefer [facility]. I ask not to be taken to [facility] because [reason].

9. Notification. Please notify [name, relationship, phone] as soon as possible. Please do not notify [name] / do not contact my employer.

10. Who decides for me. I have named [name] as my health care agent in a separate document dated [date].

11. Practical matters. If I am hospitalized, please make sure: [my cat is fed — contact ____] · [my rent is paid — the account is set to auto-pay] · [my employer is told I am on medical leave, nothing more].

12. Duration and revocation. This directive remains in effect until I revoke it. I may revoke it when I have capacity to do so.

[Signature] · [Date] [Witnesses / notary as your state requires — check, this varies]

Note. The best directives are written in the person's own voice and include the small operational facts — the cat, the hearing aid, the standing on the right. Those details do more work in an actual hospital than the formal consent provisions do.

Template 2 — Release of information

The one-page document that solves the "the hospital won't tell me anything" problem. Sign several. Name several people. Give a copy to each of them and put one in the file at each hospital in the county.

AUTHORIZATION FOR RELEASE OF INFORMATION

I, [name], date of birth [date], authorize [facility / provider / any treating facility] to disclose information about my care to:

Name Relationship Phone Email

Information authorized: [ ] Whether I am present at the facility · [ ] My general condition · [ ] Diagnosis and treatment plan · [ ] Medications · [ ] Discharge planning and date · [ ] Complete medical record · [ ] Other: ______

Limits: I do not authorize disclosure of: [substance use treatment records / specific content / other].

Purpose: To allow my family to assist in my care and discharge planning.

Expires: [date, or "upon revocation"].

I understand I may revoke this in writing at any time, except as to disclosures already made.

[Signature] · [Date] · [Witness]

Note. Substance use disorder records from federally assisted programs carry separate protections and generally require their own specific authorization. If those records matter, say so explicitly on a separate form.

Template 3 — Crisis card

Wallet-sized. Printed. Carried. This single index card has changed more emergency department encounters than any formal instrument in this toolkit.

MEDICAL / CRISIS INFORMATION — [Name] DOB [ ] · Blood type [ ] · Allergies [ ]

Diagnosis: [ ] Medications: [drug — dose — frequency; list all, including non-psychiatric] Prescriber: [name, phone] · Pharmacy: [name, phone] Emergency contacts: [name — relationship — phone] × 2 I have a psychiatric advance directive. Copy held by: [name, phone] I have a health care agent: [name, phone]

[One personal line on the back — this is the part that matters.] "I may seem agitated or may not answer questions well. I am not dangerous. Please call my sister at [number]. Letting me stand up and walk helps."

Template 4 — Supported decision-making agreement

An alternative to guardianship, recognized by statute in a majority of states. The person keeps legal authority; supporters help them understand, weigh, and communicate decisions. Where the state has a statutory form, use the statutory form.

SUPPORTED DECISION-MAKING AGREEMENT

I, [name], am making this agreement voluntarily. I am not giving anyone authority to make decisions for me. I am asking the people named below to help me make my own decisions.

My supporters:

Name Relationship Areas of support Phone
Health care
Money and benefits
Housing

What my supporters may do:

  • Help me gather and understand information
  • Help me weigh options and consequences
  • Be present with me at appointments and meetings
  • Help me communicate my decision to others
  • Receive information about me for these purposes (a separate release is attached)

What my supporters may NOT do:

  • Make any decision for me
  • Sign anything on my behalf
  • Override a decision I have made

I understand that I may end this agreement at any time, for any reason, by telling my supporters or by writing.

[Signature] · [Date] [Supporter signatures and dates] [Witnesses / notary as your state requires]

Note. When a guardianship petition has been filed, an executed supported decision-making agreement is direct evidence that a less restrictive alternative exists — which most guardianship statutes require the court to consider before appointing a guardian.

Template 5 — Collateral information letter

For the family member the hospital will not talk to. This is the document that answers "there is nothing I can do." Deliver it to the unit, ask that it be placed in the chart, and keep a copy.

RE: [Patient name], DOB [date] — collateral information from family To: Treatment team, [Unit], [Hospital] From: [Your name], [relationship], [phone], [email] Date: [ ]

I understand you cannot disclose information to me without authorization. I am providing information, not requesting it. Please place this in the chart and share it with the treating psychiatrist.

Baseline. When well, [name] [works as ___ / lives independently at ___ / manages his own medications / sees Dr. ___ monthly]. This is what he is like at baseline: [two sentences].

Timeline of the current episode.

  • [Date] — [specific observable fact]
  • [Date] — [quoted statement]
  • [Date] — [behavior]
  • [Date] — [what precipitated the hospitalization]

Sleep, food, weight. [Specifics with dates and numbers.]

Medications. Prescribed: [drug, dose, prescriber]. Adherence: [last taken, when stopped, why if known]. Pharmacy: [name, phone].

What has worked before. [Medication, setting, approach — with the hospitalization it came from.]

What has not worked, or has gone badly. [Specific — a medication with intolerable side effects, a facility with a bad outcome, restraint history.]

Medical conditions you should know about. [Diabetes, seizure disorder, CPAP, hearing loss, the fact that he cannot read without the glasses that are in my car.]

Substances. [Honest.]

Support available at discharge. [Precisely what you can and cannot do. "He can live with me. I work 7 to 4 and cannot supervise during the day. I can drive him to appointments on Tuesdays and Thursdays."]

Safety. [Access to firearms — and whether they have been removed. Access to means. Prior attempts, with dates.]

I am available at [phone] at any hour.

[Signature]

Note. The "support available at discharge" section is the one people get wrong in both directions. Overstate it and you get a discharge you cannot manage. Understate it and you may extend a commitment. Say exactly what is true.

Template 6 — Discharge plan

Bring this to the hearing. A judge cannot order an alternative nobody presented, and "he can stay with family" is not an alternative — it is a hope. This is an alternative.

PROPOSED DISCHARGE PLAN — [Patient name], Case No. [ ]

1. Residence. [Full street address]. [Owner/leaseholder name] has agreed to [name] residing there [indefinitely / for ___ days]. A signed statement from [name] is attached as Exhibit A.

2. Supervision. [Name], [relationship], will be present [describe honestly — "evenings and weekends"; "daily from 5 p.m."]. [Name] understands the treatment plan and has agreed to contact [provider / crisis line] if [specific warning signs] appear.

3. Clinical follow-up. Appointment scheduled with [Provider name], [clinic], on [date] at [time]. Confirmation attached as Exhibit B. Subsequent appointments: [frequency].

4. Medication. [Drug, dose, frequency]. Prescription to be filled at [pharmacy, address]. Cost: [$__ / covered by ___ / patient assistance application submitted [date]]. [Name] will [pick up / administer / verify].

5. Transportation. [Name] will drive. / Bus route [], stop at [], [__] minutes. / Medicaid transportation authorized — confirmation attached as Exhibit C.

6. Income and benefits. [Current status. Applications filed on [date]. Representative payee: [name], appointed [date].]

7. Crisis plan. Written and provided to [name]: 988 · mobile crisis [number] · [provider] after-hours [number] · [two personal contacts].

8. Safety. Firearms removed from the residence on [date] and stored with [name] at [address]. Medications limited to [__] day supply, held by [name].

9. Conditions. [Name] agrees to: attend all scheduled appointments · take medication as prescribed · [any other condition the person will genuinely accept].

This plan is less restrictive than continued hospitalization and adequately addresses the concerns raised in the petition.

Attached: Exhibit A — statement of [name]; Exhibit B — appointment confirmation; Exhibit C — transportation authorization.

Note. Exhibits A and B are the whole document. A signed statement from the person who will be there and a confirmed appointment on a specific date are what make this real rather than aspirational. Get them before the hearing.

Template 7 — Medication objection statement

A commitment order does not authorize medication. This puts the objection on the record and, more usefully, converts a global refusal into a specific and often winnable position.

OBJECTION TO MEDICATION OVER OBJECTION — [Patient name] To: Treating psychiatrist and [independent reviewer / court] Date: [ ]

I object to being given [medication] against my will. I request the hearing or review to which I am entitled, and I request an advisor or advocate.

My objection is specific.

[ ] I object to this medication because [reason — side effect experienced, allergy, prior adverse reaction, interaction with a medical condition]. I am willing to take [alternative] instead.

[ ] I object to this dose. I am willing to take [lower dose].

[ ] I object to the route. I am willing to take an oral formulation but object to a long-acting injection.

[ ] I object to all antipsychotic medication because [reason].

Relevant history. [Specific: "In 2023 at ___ Hospital I was given ___ and developed ___. The record should be available from that facility."]

My advance directive. I executed a psychiatric advance directive on [date] addressing this. A copy is [attached / held by ___].

What I am asking for. [A trial of ___ · a lower dose · time to discuss with my agent · a second opinion.]

[Signature] · [Date]

Note. The federal floor requires review by independent medical decisionmakers, not necessarily a judge; some states require judicial authorization, which is more protective. Ask which applies before assuming.

Template 8 — Independent evaluation request

Available in most states, frequently at public expense, and almost never requested. It takes time to arrange — ask early.

RE: [Patient name], Case No. [ ] — request for independent evaluation To: [Appointed counsel] / [Court]

I request appointment of an independent examiner under [state statute, if known] to evaluate [name] in connection with the pending commitment petition.

Grounds. The petition rests on the opinion of the treating psychiatrist, who has [known the patient for ___ days / evaluated him on ___ occasions totaling approximately ___ minutes]. An independent evaluation would address:

  1. Whether [name] meets the statutory standard of [grave disability / dangerousness];
  2. Whether the proposed alternative placement is clinically adequate;
  3. [Whether the current medication regimen is appropriate];
  4. [Whether the presentation is attributable to delirium, medication effect, or an untreated medical condition rather than a primary psychiatric illness].

I request that the examiner be provided the collateral information submitted by [family member] on [date], and the records from [prior facility].

[Signature] · [Date]

Note. Item 4 is worth including whenever the patient is over sixty-five or the onset was abrupt. Delirium from infection, medication, or withdrawal is commonly mistaken for a psychiatric illness, and the question is rarely asked once someone lands on a psychiatric unit.

Template 9 — Protection and Advocacy complaint

Every state and territory has one. Services are free. They have facility access and records authority that families do not.

RE: Request for investigation — [Facility name] To: [State] Protection and Advocacy agency

I am [relationship] of [name], DOB [date], currently at [facility, unit, room].

What I am reporting.

  • [Date] — [specific observed or reported event]
  • [Date] — [specific]

Category (check what applies): [ ] Physical abuse [ ] Neglect [ ] Denial of prescribed medication or medical care [ ] Improper restraint or seclusion [ ] Denial of rights (mail, phone, visitors, advocate access) [ ] Unjustified institutionalization when community placement is appropriate [ ] Retaliation for complaining

What I have already done. I raised this with [name, title] on [date]. The response was [ ]. I filed a grievance on [date]; the outcome was [ ].

Community placement. [If applicable:] [Name]'s own treatment professionals have determined that community placement is appropriate; this appears in [document, date]. [Name] does not oppose community placement. He has remained institutionalized for [duration] notwithstanding that determination.

Authorization. [Name] has signed the attached release authorizing your agency to access his records and to speak with him. [Or: I am requesting that you exercise your independent access authority.]

[Signature] · [Date] · [Phone]

Note. The community placement paragraph is the Olmstead argument in plain form. It is the strongest argument available when someone is stuck in a facility that everyone agrees they no longer need.

Template 10 — Jail medication notice

Deliver to the jail medical unit and to defense counsel the same day. Missed doses cause decompensation, and decompensation makes every subsequent legal problem harder.

RE: [Name], booking no. [ ] — urgent medical information To: Medical / Mental Health Unit, [Jail] Copy: [Public defender / attorney]

[Name] was booked on [date]. He has a diagnosis of [ ] and is prescribed:

Medication Dose Frequency Prescriber Pharmacy

Last dose taken: [date, time, to the best of my knowledge].

Consequences of interruption. [Specific: "When he has missed doses previously, he has decompensated within four to six days, with [symptoms]." Attach records if you have them.]

Medical conditions: [ ]. Allergies: [ ].

Suicide risk history: [Attempts with dates, or "none known."] I request a suicide risk screening.

Records. [Prescriber] can be reached at [phone] and has authorization to release records; a signed authorization is attached.

Contact. [Name, relationship, phone] — available at any hour.

[Signature] · [Date]

Template 11 — Employer accommodation request

RE: Request for accommodation / medical leave To: [Supervisor / HR]

I am requesting [an accommodation / medical leave] related to a health condition.

What I am requesting: [Leave from ___ to ___ / a modified schedule of ___ / remote work on ___ / a later start time to accommodate a medication schedule / intermittent leave for appointments].

Duration: [ ]. Expected return: [ ].

Medical documentation: Attached / to be provided by [date] from [provider].

I am not requesting disclosure of my diagnosis and understand that I am not required to provide it. I am happy to have my provider confirm the functional limitations and the accommodation needed.

Please treat this as confidential and keep it separate from my personnel file, as required.

[Signature] · [Date]

Note. You generally need to disclose the need and the functional limitation, not the diagnosis. Say so politely and in writing; it establishes both the request and its date.

A short list of things that are not documents

  • Bring the glasses and the hearing aids. A person evaluated without them presents as far more impaired than they are.
  • Write the dated facts before you call, not while the crisis team is in your kitchen.
  • Ask for the unit social worker. Reachable, and the person who builds the discharge plan.
  • Get the appointment confirmation on paper before the hearing. It is the single most persuasive object in the room.
  • Ask about the restoration wait before raising competency in a criminal case.
  • Do the paperwork while well. Nobody does it. It is the highest-leverage hour available.

Related documents

Educational only, not legal advice. Templates must be adapted to your state's statutes and forms. Advance directive execution requirements, medication review procedures, and supported decision-making recognition vary substantially by state.