Authorization to Apply for Hospitalization Pursuant to M.G.L. c.123, § 12(a)

(1) The following persons may perform an examination and apply for hospitalization pursuant to M.G.L. c. 123, § 12(a): (a) Physician. Any physician who is licensed pursuant to M.G.L. c. 112. (b) Qualified Psychologist. A psychologist who is licensed pursuant to M.G.L. c. 112, §§ 118 through 129A. (c) Qualified Advanced Practice Registered Nurse (APRN). A registered nurse licensed under M.G.L. c. 112, § 80B and authorized by the Board of Registration in Nursing to practice as an Advanced Practice Registered Nurse. (d) Licensed Independent Clinical Social Worker (LICSW). A social worker who is licensed pursuant to M.G.L. c. 112, §§ 130 through 137. (2) In an emergency, if a physician, Qualified Psychologist, Qualified APRN or an LICSW is not available, a police officer may apply for hospitalization pursuant to M.G.L. c. 123, § 12(a). (3) Application for hospitalization pursuant to M.G.L. c. 123, § 12(a) shall be made upon such form as is prescribed by the Commissioner.