How to Fill Out the DHCS 1801: California’s 5150 Hold Application

To fill out the DHCS 1801, an authorized professional works through the form in order: document the oral advisement given to the person at the moment of detention, identify the individual and the receiving facility (including the exact start time of the hold), write a factual narrative supporting probable cause, check the applicable criterion — danger to self, danger to others, or grave disability — record the required notifications to the county behavioral health director and peace officer, and sign and date the certification. The form is California’s standard application for a 72-hour involuntary psychiatric hold under Welfare and Institutions Code Section 5150, and the current version was revised in March 2026.¹ Providers may adapt it or use their own form as long as every legally required field is captured.²

Confirm You Have the Legal Authority to Complete It

Section 5150 limits who may initiate the hold. Five categories of people qualify: peace officers, the professional person in charge of a county-designated evaluation and treatment facility, attending staff at that facility, members of a county-designated mobile crisis team, and other professionals specifically designated by the county.³ Family members and other concerned individuals cannot complete the DHCS 1801 themselves; their role is to call 911, a county crisis line, or request a mobile crisis response so that an authorized professional can make the assessment.

If your probable cause depends on a statement from someone who is not authorized to initiate the hold, that informant can be held civilly liable for a knowingly false statement, so record their identifying information carefully.³

Complete the Advisement Section First

The top of the form documents that the person being detained was told what is happening. Section 5150(g)(1) requires the advisement to be given orally at the time custody begins, in a language or communication method the person can understand. If a spoken advisement is not possible, it must be provided in writing.¹

The form includes the exact script. Read it to the person: identify yourself by name and role, state that they are not under criminal arrest, name the facility where they are being taken for a behavioral health examination, and tell them facility staff will explain their rights on arrival. If custody begins at the person’s home, an additional statement covers their ability to bring approved personal items, ask for help turning off appliances or water, make a phone call, and leave a note for family.¹

Mark whether the advisement was completed in full or incomplete. If incomplete, you must write a good-cause explanation, for example that the person was unconscious, combative, or spoke a language no available interpreter could translate. Record your name, position, the language or communication method used, and the date.

Identify the Individual and Facility

The application section captures who is being detained, where they are going, and when the clock started. The fields are straightforward but one entry deserves special attention.

Facility name: the county-designated 5150 evaluation and treatment facility receiving the person.
Individual’s name and date of birth.
Address: the person’s residence.
Detainment start date and time: enter the moment the person was first taken into custody, not the arrival time at the facility. The 72-hour clock runs from first detention.³

For minors or conservatees who cannot consent to voluntary treatment, add the name and contact information of the parent, legal guardian, or conservator with authority to make medical decisions. If the minor is a dependent of the juvenile court under WIC Section 300 or a ward under Sections 601 or 602, note that status.¹

Document Probable Cause in the Narrative

This is the section that most often causes problems when it is done poorly. Vague language will not satisfy the probable cause standard. You must describe three things in your own words.

How the situation came to your attention: the circumstances under which the person’s condition was first observed or reported.
Specific facts supporting the hold: concrete observations. What the person said, what behaviors you or others witnessed, what physical evidence you saw. These are what establish probable cause.
Historical course: any relevant history of the person’s mental health disorder, substance use disorder, or co-occurring conditions that you considered. AB 1194 made this a statutory requirement, and the form gives you dedicated space for it.²

Record who provided the history: their name, address, phone number, and relationship to the person being detained. Their credibility is now part of the record supporting the hold.³

Check the Applicable Criterion

After the narrative, check the box or boxes that identify the probable cause you have documented: danger to self as a result of a mental health disorder, danger to others as a result of a mental health disorder, or gravely disabled. The gravely disabled category has separate boxes for a mental health disorder alone, a severe substance use disorder alone, or co-occurring conditions. A separate checkbox references the standard in WIC Section 5585.25 for gravely disabled minors.¹

Grave disability under WIC Section 5008, as amended by SB 43 (fully effective 2026), means a person who as a result of a mental health disorder, a severe substance use disorder, or both cannot provide for their own food, clothing, shelter, personal safety, or necessary medical care.⁴⁵ Intellectual disability by itself does not qualify.

Record Notifications and Sign the Certification

The bottom of the form captures two required notifications under Sections 5152.1 and 8102: the name and phone number of the county behavioral health director (or designee), and the name and phone number of the relevant peace officer (or designee).¹

Two checkboxes ask whether the peace officer or behavioral health director wants to be notified before the person is released, and for what reason: the person’s actions could support a criminal complaint, or a weapon was confiscated under WIC Section 8102. Check whichever apply.

Then sign. Print your name, title, badge number if you are a peace officer, agency or facility, address, and the date and time. A copy of the completed application has the same legal effect as the original.¹

What the DHCS 1801 Does Not Cover

The 1801 authorizes only the initial 72-hour hold. If the treatment team later certifies the person for up to 14 additional days under WIC Section 5250, that certification uses the DHCS 1802, and other involuntary treatment processes use the DHCS 1808 and 1809. Like the 1801, those forms are optional templates that providers may adapt.²

The 72-hour window is also a maximum. If the professional in charge of the receiving facility determines the person can be properly served without detention, the person must be offered evaluation, crisis intervention, or other services voluntarily instead. The person can also be released at any point during the 72 hours if the criteria are no longer met.³

A Consequence to Be Aware Of: Firearms Restrictions

If the hold you initiate leads to admission on the basis of danger to self or others (not grave disability alone), it triggers a five-year prohibition on the person owning, possessing, or purchasing firearms, other deadly weapons, or ammunition. A second admission under the same criteria within a year makes that ban permanent.⁶

The trigger is admission, not the length of the stay, so the restriction applies even if the person is released before the 72 hours run out. A person subject to the ban may petition the superior court in their county of residence for relief; the court must set a hearing within 60 days, and the state bears the burden of proving by a preponderance of the evidence that the person would not use firearms safely and lawfully.⁶

Where to Get the Current Form

The March 2026 revision of the DHCS 1801 is available as a PDF from the California Department of Health Care Services at dhcs.ca.gov. County behavioral health departments and designated facilities generally stock printed copies for field use, and many counties use customized versions integrated into electronic health records. Any of those versions is acceptable as long as it captures every legally required piece of information.²

1
Department of Health Care Services. DHCS 1801 – Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
2
California Department of Health Care Services. Behavioral Health Information Notice No. 20-004
3
California Legislative Information. California Welfare and Institutions Code 5150
4
California Legislative Information. California Welfare and Institutions Code 5008
5
California Department of Health Care Services. Senate Bill 43, Changes to Gravely Disabled Behavioral Health FAQs
6
California Legislative Information. California Welfare and Institutions Code WIC 8103