To fill out the California 5150 form, known officially as DHCS 1801, you record the receiving facility and the person’s identifying information, mark the exact date and time the person was first detained, document the advisement of rights, write a specific factual narrative supporting probable cause that the person is a danger to self, a danger to others, or gravely disabled because of a mental health disorder, check the applicable probable cause boxes, and sign as an authorized official. The current form is dated March 2026 and is available from the California Department of Health Care Services and at county-designated evaluation and treatment facilities.1California Department of Health Care Services. Mental Health Forms
Confirm You Are Authorized To Sign
Only certain people can legally initiate a 5150. Welfare and Institutions Code section 5150 authorizes peace officers, the professional person in charge of a county-designated evaluation facility, attending staff at such a facility, designated members of a mobile crisis team, and any professional person designated by the county.2California Legislative Information. Welfare and Institutions Code WIC 5150 – Detention of Persons with a Mental Health Condition for Evaluation and Treatment Counties keep their own lists of designated professionals and typically require completion of a 5150 certification training program.
If you are a family member or friend, you cannot sign the application yourself. What you can do is provide information to someone who can. The authorized person making the decision is required to consider mental health history that has a reasonable bearing on whether the individual is dangerous or gravely disabled, and that history can come from providers, family, the person being evaluated, or anyone they designate. Be aware that a person who intentionally provides false information used as the basis for probable cause can be held civilly liable.3California Legislative Information. California Welfare and Institutions Code 5150.05
What Probable Cause Must Look Like
The form is only as strong as the facts you put in it. Probable cause under WIC 5150 requires a belief that, because of a mental health disorder, the person meets one of three criteria: danger to self, danger to others, or grave disability.2California Legislative Information. Welfare and Institutions Code WIC 5150 – Detention of Persons with a Mental Health Condition for Evaluation and Treatment The behavior has to connect to the disorder; behavior alone is not enough if it stems from something else.
Danger to self generally means a life-threatening risk such as a recent suicide attempt, active suicidal behavior, or serious self-harm. Danger to others covers violent actions, credible threats, or behavior that puts another person at risk of harm; the threat does not have to be happening at that exact moment but must be substantially connected to the mental health condition.4Kern County, CA – Behavioral Health and Recovery Services. What is a 5150 Hold or 72-Hour Hold Grave disability means the disorder leaves the person unable to provide for their own food, clothing, or shelter, and the inability must result from the disorder itself rather than poverty or a lack of resources.5Disability Rights California. Understanding the Lanterman-Petris-Short (LPS) Act The current DHCS 1801 also includes separate checkboxes for grave disability caused by a severe substance use disorder or by co-occurring mental health and substance use disorders.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
Section by Section: How To Complete DHCS 1801
Identifying Information and the Detainment Time
At the top of the form, enter the name of the receiving facility, the individual’s full name, date of birth, and home address. Record the detainment start date and start time carefully. The 72-hour clock starts the moment the person is first detained, not when they arrive at the facility, so this entry sets the legal timeline for the entire hold.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment If the person is a minor or a conservatee for whom voluntary treatment authorization is unavailable, indicate who has legal authority to make medical decisions on their behalf.
Advisement Section
The advisement section documents that you told the person why they are being detained and what is about to happen. Record the date of the advisement or attempted advisement, the language or modality used, and your name and position. If the advisement could not be completed because the person was too agitated, unconscious, or otherwise unable to receive it, note the good cause for the incomplete advisement in the space provided.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment Do not leave this blank; a missing advisement without a documented reason is a due-process problem for the hold.
Circumstances and Factual Basis for Probable Cause
This is the section receiving staff will read most closely. Describe the circumstances that brought the person’s condition to your attention, then lay out the specific facts supporting your belief that they meet one of the three criteria. The statute requires the application to state both the circumstances and the factual basis for probable cause.2California Legislative Information. Welfare and Institutions Code WIC 5150 – Detention of Persons with a Mental Health Condition for Evaluation and Treatment
Write concretely. “Patient appears suicidal” tells the facility nothing. Instead, describe what you observed: where the person was, what they said (in their own words when possible), what they did, who else was present, and what physical evidence existed. If they threatened someone, record the exact words and who was threatened. If a weapon was involved, say so. Clinical labels are far less useful than a clear picture of behavior, speech, and environment.
The form also asks whether you considered the historical course of the person’s mental health disorder, as required by WIC 5150.05. If a family member, friend, or provider shared relevant history, record that person’s name, address, phone number, and relationship to the individual in the designated space.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
Probable Cause Checkboxes and Signature
After the narrative, check every box that applies: danger to self, danger to others, or one of the grave disability categories, which include the options for severe substance use disorder and co-occurring disorders. The form ends with your signature, your title, and, for peace officers, your badge number.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
Notification Request
A separate section lets a referring peace officer request that the facility notify them if the person is released. Use this when a criminal complaint could be filed based on the circumstances, or when a weapon was confiscated during the detention.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
The Oral Advisement You Give in the Field
The statute prescribes a specific advisement the person taking someone into custody must deliver. It identifies you by name, states your role and agency, tells the person they are not under criminal arrest, names the facility where they are being taken, and lets them know facility staff will explain their rights on arrival.7California Legislative Information. California Code Welfare and Institutions Code – WIC 5150 The advisement must be given in a language or modality the person can access. If they cannot understand an oral advisement, provide it in writing.
When the person is taken into custody at their own home, tell them they may bring a few approved personal items, ask whether they need help turning off appliances or water, and let them make a phone call and leave a note so friends or family know where they are going.7California Legislative Information. California Code Welfare and Institutions Code – WIC 5150 What you say and whether it was completed then gets recorded in the advisement section of the form.
After You Sign: Transfer, Weapons, and the Clock
The completed DHCS 1801 travels with the person to the designated facility and is handed to intake staff. That transfer of the signed application is the legal mechanism that shifts custody from the initiating official to the facility, where a licensed mental health professional will evaluate whether probable cause holds up.
If you are a peace officer, determine before or during transport whether the person owns or has access to firearms or other deadly weapons. Weapons found during the process may be seized and booked for safekeeping. Provide a receipt and a written Notice of Rights explaining the seizure. If the person is too agitated or incapacitated to sign the notice, document the reason. The district attorney’s office then has 30 days from the date of detention to file a petition in Superior Court to prevent the return of the weapon, and if the individual contests it, a hearing must be set within 30 days of their request.
The 72-hour clock runs from the moment of detention and includes weekends and holidays.6California Department of Health Care Services. Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment The facility can release the person earlier if the clinical evaluation does not support continued detention, and it must provide a care coordination plan with a follow-up behavioral health appointment before release.8California Legislative Information. California Code Welfare and Institutions Code – WIC 5152 If the person can be served without detention, the facility should offer voluntary evaluation and treatment instead.2California Legislative Information. Welfare and Institutions Code WIC 5150 – Detention of Persons with a Mental Health Condition for Evaluation and Treatment
One boundary worth flagging as you write the form: a 5150 hold that results in admission specifically because the person was found to be a danger to self or others triggers an automatic five-year firearms prohibition under WIC 8103; a hold based solely on grave disability does not.9California Legislative Information. California Welfare and Institutions Code 8103 The boxes you check therefore carry consequences beyond the 72 hours, which is another reason the factual narrative should match the criteria you select.