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.