A. The emergency certificate shall state all of the following:
(1) The date the physician, family psychiatric mental health nurse practitioner, or psychologist examined the minor, which shall not be more than seventy-two hours prior to the date of the signature of the certificate.
(2) The objective findings of the physician, family psychiatric mental health nurse practitioner, or psychologist relative to the physical and mental condition of the minor, leading to the conclusion that he is dangerous to himself or others or is gravely disabled as a result of substance abuse or mental illness.
(3) The history of the case, if known.
(4) The determination of whether the minor examined is in need of immediate psychiatric treatment in a treatment facility because he is either:
(a) Dangerous to himself.
(b) Dangerous to others.
(c) Gravely disabled.
(5) A statement that the minor is unwilling or unable to seek voluntary admission.
B. The certificate shall be dated and executed under the penalty of perjury, but need not be notarized. The certificate shall be valid for seventy-two hours and shall be delivered to the director of the treatment facility where the person is to be further evaluated and treated.
Acts 1991, No. 235, §14, eff. Jan. 1, 1992; Acts 2012, No. 489, §1.