Anatomy of a Baker Act: Week 1

Greetings, readers! Ever wondered what a Florida Baker Act form looks like? (This is the form which mandates an individual to be examined by a mental health provider involuntarily). Over the next few weeks, I will be reviewing interesting facts about Baker Acts and their importance when providing patient care. Today, we will look at some very basic aspects of this form:

Certificate of Professional Initiating Involuntary Examination (CF – MH 3052b Jul. 2020: Certificate of Professional Initiating Involuntary Examination)

Please note: This form is NOT the one which is used by law enforcement; we will look at that version at a later time.

Baker Act forms contain sections of information about the person for whom the Baker Act is being initiated, as follows:

Section I: Criteria (First and foremost, the person must either have a diagnosis of a mental illness or it is believed that the person has one.)

Section II: Supporting Evidence (This includes observations of the individual’s behavior, statements made, such as presence of suicidal or homicidal thoughts, and other relevant information.)

Section III: Other Information (such as collateral information provided by family, bystanders, or clinical records)

Section IV: Involuntary Examination for Outpatient Services Orders (This is related to a person’s failure to comply with an involuntary outpatient services order.)

Section V: Information for Law Enforcement

Section VI: Signature

You will notice that it clearly states on the Baker Act that the ORIGINAL form must be retained in the clinical records:

This form must be transported with the individual to the receiving facility to be retained in the clinical record.  Copies may be retained by the initiating professional and by the law enforcement agency transporting the individual to the receiving facility.”


Nurses, make sure that the original Baker Act always remains in the clinical record, even if the Baker Act is discontinued at some point. Also, never assume that the form is in the chart if you have not viewed it yourself. Though rare, it is always possible that the original did not arrive with the patient, or that the Baker Act form was not retained by staff. Remember, caring for a patient in a Baker Act Receiving Facility requires strict adherence by all staff to Florida Statutes. For more information, refer to Substance Abuse & Mental Health – Florida Department of Children and Families (

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