Updated Form Required for Single Bed Certifications

July 12, 2017


To:                      COOs, CNOs, and Legal Counsel

                            Please forward to: Emergency Department and Psychiatric Unit Administrators

From:                Chelene Whiteaker, Policy Director

Staff Contact: Chelene Whiteaker: chelenew@wsha.org or 206-216-2545

Subject:            Updated Form Required for Single Bed Certifications



The purpose of this bulletin is to inform hospitals to use the updated Single Bed Certification (SBC) form for mental health patients who are involuntarily detained under RCW 71.05. To ensure SBCs are accepted for patients, hospitals need to use the updated form.

Please disregard this bulletin if your hospital does not accept patients on Single Bed Certifications.


WSHA advices hospitals to use this updated form to avoid having patients released on technicalities from the court system or receiving a denial of the SBC from the Department of Social and Health Services. In particular, hospitals with patients on 90 or 180 day involuntary commitment orders need to be diligent in the use of the new form.

There are two versions of the form depending on the location of your facility (click on the link for the new form):

  1. Hospitals in eastern Washington: SBC form sent to Eastern State Hospital; or
  2. Hospitals in western Washington: SBC form sent to Western State Hospital.


Please see the data dictionary for definitions relating to the SBC form.


If your hospital cares for patients on SBCs, please ensure you are using this new form. The new form could be used in a variety of areas within your hospital.

  • Emergency department; or
  • Inpatient units (psychiatric or medical).


In re Detention of DW found the practice of boarding involuntarily detained mental health patients without providing active treatment to be a violation of their civil rights. An emergency rule was established on the criteria for accepting a patient on a SBC on April 21, 2015.

Background and References

WSHA bulletin on SBC: New Emergency Rule for Patients with Medical Conditions from May 12, 2015


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