The New York OMH Form 471 is the state’s Application for Involuntary Admission on Medical Certification under Mental Hygiene Law §9.27. An authorized applicant — usually a family member, hospital director, or social services official — completes it with identifying information and a written statement of facts describing why the person is mentally ill and in need of involuntary care, then submits it to the director of the receiving hospital along with two separate 471A certificates from examining physicians or a physician and a psychiatric nurse practitioner.1New York State Senate. New York Mental Hygiene Law 9-27 – Involuntary Admission on Medical Certification The patient does not fill out this form. It is filed on their behalf.
Who Is Allowed to Sign the Application
Mental Hygiene Law §9.27 limits who can execute the OMH 471. If you do not fall into one of the listed categories, the application will not be accepted, no matter how well-documented your concerns are. The authorized applicants are:
- A parent, spouse, adult child, sibling, or the nearest available relative, along with anyone who lives with the person.
- The director of the hospital where the person is already receiving care, or the director of a general hospital.
- The director of community services or a social services official in the city or county where the person is located.
- An officer of a public or recognized charitable institution where the person resides, including the superintendent of a correctional facility or the designee handling community supervision after incarceration.
- The director or person in charge of a facility providing care for people with alcohol or substance use disorders.
- A social services official or authorized agency with custody of a child over 16, or a person or entity with custody under a Family Court order.
- A qualified psychiatrist supervising or treating the person for mental illness at an OMH-licensed or OMH-operated facility.
The signature must be dated within ten days before the person is admitted. The applicant signs under penalty of perjury, but the form does not have to be notarized.1New York State Senate. New York Mental Hygiene Law 9-27 – Involuntary Admission on Medical Certification
What the OMH 471 Asks For
The form collects identifying information about the applicant and the person alleged to be mentally ill, and it asks for a written statement of facts explaining why the applicant believes the person is mentally ill and in need of involuntary care and treatment.
That factual statement is the substantive part of the application. It should describe specific behaviors, incidents, and observed conditions rather than conclusions. Language like “he has been acting strangely” or “she is a danger to herself” without concrete examples gives the receiving hospital little to work with, and vague or conclusory statements can lead the hospital to question whether the statutory standard is met. Dates, direct observations, statements the person has made, and descriptions of specific incidents carry more weight than general impressions.
Because the application is signed under penalty of perjury, statements that the applicant knows to be false carry criminal consequences. The form itself is available as a PDF through the New York State Office of Mental Health website or from the administrative office of any OMH-licensed hospital.2New York State Office of Mental Health. OMH Forms
The Two 471A Certificates That Must Accompany It
The OMH 471 does not stand alone. Two separate certificates of examination, each on Form 471A, must accompany it. The law permits two examining physicians, or one examining physician together with a psychiatric nurse practitioner. They may examine the person jointly, but each signs their own certificate independently.1New York State Senate. New York Mental Hygiene Law 9-27 – Involuntary Admission on Medical Certification
Before certifying, each examining practitioner has to consider whether alternative forms of care could meet the person’s needs without involuntary hospitalization. If the practitioner knows the person has been under prior treatment, they should consult with the previous treating physician or psychologist before completing the certificate.1New York State Senate. New York Mental Hygiene Law 9-27 – Involuntary Admission on Medical Certification
Without both 471A certificates, the application package is incomplete and the hospital cannot proceed with an involuntary admission under §9.27.
Form 471B: When Transport Is Needed
Form 471B is optional. It is used only when the person needs to be taken into custody and transported to the hospital. An examining physician or psychiatric nurse practitioner who has already signed a 471A certificate may complete a 471B requesting that a peace officer, police officer, or ambulance service bring the person in. The 471B can be completed only after both practitioner certificates and the admission application are already done.3New York State Office of Mental Health. MHL 9-27 Forms 471, 471A, 471B
Filing the Package and What Happens Next
The completed OMH 471, the two 471A certificates, and any 471B go to the director of the receiving hospital. Submitting a complete package does not guarantee admission. The hospital director must have the person examined by a staff psychiatrist who was not one of the two original certifying practitioners. Only if that independent examiner also confirms that the person needs involuntary care and treatment will the hospital admit them as an involuntary patient.1New York State Senate. New York Mental Hygiene Law 9-27 – Involuntary Admission on Medical Certification
Once admitted, the patient can be held on involuntary status for up to 60 days from the date of admission. During that period, the patient, a relative, a friend, or the Mental Hygiene Legal Service may request a court hearing to challenge the admission. If the hospital wants to hold the patient beyond 60 days and the patient will not stay voluntarily, the hospital has to apply to the supreme or county court for a retention order under MHL §9.33.1New York State Senate. New York Mental Hygiene Law 9-27 – Involuntary Admission on Medical Certification
How This Differs From an Emergency Admission
The §9.27 process is not the right path when someone is in immediate crisis. Emergency psychiatric admission under MHL §9.39 allows a hospital director to receive and hold a person for up to 15 days when there is a likelihood of serious harm, meaning a substantial risk the person will physically hurt themselves, hurt others, or cannot meet basic survival needs like food, shelter, or medical care because of mental illness.4New York State Senate. New York Mental Hygiene Law 9-39 – Emergency Admissions for Immediate Observation, Care, and Treatment
An emergency admission does not require the OMH 471 or the two outside physician certificates. A staff physician at the hospital examines the person and makes the determination, with a second psychiatric staff member confirming within 48 hours. If the person still needs involuntary care after the 15-day emergency period and will not remain voluntarily, the hospital then has to convert them to a §9.27 admission, which is when the OMH 471 and 471A certificates come into play.4New York State Senate. New York Mental Hygiene Law 9-39 – Emergency Admissions for Immediate Observation, Care, and Treatment
Access to the Patient’s Records After Filing
Filing the OMH 471 on someone’s behalf does not, by itself, give the applicant access to the patient’s medical records afterward. A person formally authorized under state law to make health care decisions for the patient, such as a legal guardian or someone holding a health care proxy, is treated as the patient’s “personal representative” under HIPAA and can access protected health information within the scope of that authority.5HHS.gov. Guidance – Personal Representatives
Family members and friends who are involved in the patient’s care but do not hold formal legal authority have more limited access. If the patient is present and capable of making decisions, the hospital can share information with these individuals as long as the patient does not object. If the patient is incapacitated, the provider may share information based on professional judgment about the patient’s best interests, and only information directly relevant to that person’s involvement in care.