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A BILL TO BE ENTITLED
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AN ACT
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relating to the execution of a declaration for mental health |
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treatment. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Section 137.003, Civil Practice |
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and Remedies Code, is amended to read as follows: |
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Sec. 137.003. EXECUTION AND WITNESSES; EXECUTION AND |
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ACKNOWLEDGMENT BEFORE NOTARY PUBLIC. |
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SECTION 2. Section 137.003(a), Civil Practice and Remedies |
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Code, is amended to read as follows: |
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(a) A declaration for mental health treatment must be: |
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(1) signed by the principal in the presence of two or |
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more subscribing witnesses; or |
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(2) signed by the principal and acknowledged before a |
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notary public. |
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SECTION 3. Section 137.011, Civil Practice and Remedies |
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Code, is amended to read as follows: |
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Sec. 137.011. FORM OF DECLARATION FOR MENTAL HEALTH |
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TREATMENT. The declaration for mental health treatment must be in |
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substantially the following form: |
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DECLARATION FOR MENTAL HEALTH TREATMENT |
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I, __________________, being an adult of sound mind, wilfully |
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and voluntarily make this declaration for mental health treatment |
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to be followed if it is determined by a court that my ability to |
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understand the nature and consequences of a proposed treatment, |
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including the benefits, risks, and alternatives to the proposed |
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treatment, is impaired to such an extent that I lack the capacity to |
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make mental health treatment decisions. "Mental health treatment" |
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means electroconvulsive or other convulsive treatment, treatment |
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of mental illness with psychoactive medication, and preferences |
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regarding emergency mental health treatment. |
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(OPTIONAL PARAGRAPH) I understand that I may become |
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incapable of giving or withholding informed consent for mental |
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health treatment due to the symptoms of a diagnosed mental |
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disorder. These symptoms may include: |
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________________________________________________________________ |
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PSYCHOACTIVE MEDICATIONS |
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If I become incapable of giving or withholding informed |
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consent for mental health treatment, my wishes regarding |
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psychoactive medications are as follows: |
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_____ I consent to the administration of the following |
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medications: |
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________________________________________________________________ |
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_____ I do not consent to the administration of the following |
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medications: |
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________________________________________________________________ |
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_____ I consent to the administration of a federal Food and |
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Drug Administration approved medication that was only approved and |
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in existence after my declaration and that is considered in the same |
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class of psychoactive medications as stated below: |
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________________________________________________________________ |
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Conditions or limitations: ________________________________ |
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CONVULSIVE TREATMENT |
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If I become incapable of giving or withholding informed |
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consent for mental health treatment, my wishes regarding convulsive |
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treatment are as follows: |
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_____ I consent to the administration of convulsive |
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treatment. |
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_____ I do not consent to the administration of convulsive |
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treatment. |
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Conditions or limitations: ________________________________ |
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PREFERENCES FOR EMERGENCY TREATMENT |
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In an emergency, I prefer the following treatment FIRST |
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(circle one) Restraint/Seclusion/Medication. |
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In an emergency, I prefer the following treatment SECOND |
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(circle one) Restraint/Seclusion/Medication. |
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In an emergency, I prefer the following treatment THIRD |
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(circle one) Restraint/Seclusion/Medication. |
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______ I prefer a male/female to administer restraint, |
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seclusion, and/or medications. |
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Options for treatment prior to use of restraint, seclusion, |
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and/or medications: |
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________________________________________________________________ |
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Conditions or limitations: ________________________________ |
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ADDITIONAL PREFERENCES OR INSTRUCTIONS |
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________________________________________________________________ |
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Conditions or limitations: ________________________________ |
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Signature of Principal/Date: ______________________________ |
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SIGNATURE ACKNOWLEDGED BEFORE NOTARY PUBLIC |
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State of Texas |
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County of_________ |
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This instrument was acknowledged before me on ______(date) by |
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___________(name of notary public). |
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_____________________ |
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NOTARY PUBLIC, State of Texas |
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Printed name of Notary Public: |
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_____________________________ |
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My commission expires: |
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_____________________________ |
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SIGNATURE IN PRESENCE OF TWO WITNESSES |
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STATEMENT OF WITNESSES |
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I declare under penalty of perjury that the principal's name |
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has been represented to me by the principal, that the principal |
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signed or acknowledged this declaration in my presence, that I |
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believe the principal to be of sound mind, that the principal has |
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affirmed that the principal is aware of the nature of the document |
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and is signing it voluntarily and free from duress, that the |
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principal requested that I serve as witness to the principal's |
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execution of this document, and that I am not a provider of health |
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or residential care to the principal, an employee of a provider of |
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health or residential care to the principal, an operator of a |
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community health care facility providing care to the principal, or |
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an employee of an operator of a community health care facility |
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providing care to the principal. |
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I declare that I am not related to the principal by blood, |
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marriage, or adoption and that to the best of my knowledge I am not |
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entitled to and do not have a claim against any part of the estate of |
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the principal on the death of the principal under a will or by |
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operation of law. |
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Witness |
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Signature: ______________________________________________ |
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Print |
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Name: _____________________________________________________ |
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Date: ______________________ |
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Address: _______________________________________________________ |
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Witness |
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Signature: ______________________________________________ |
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Print |
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Name: _____________________________________________________ |
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Date: ______________________ |
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Address: _______________________________________________________ |
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NOTICE TO PERSON MAKING A DECLARATION FOR MENTAL HEALTH TREATMENT |
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This is an important legal document. It creates a |
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declaration for mental health treatment. Before signing this |
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document, you should know these important facts: |
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This document allows you to make decisions in advance about |
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mental health treatment and specifically three types of mental |
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health treatment: psychoactive medication, convulsive therapy, |
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and emergency mental health treatment. The instructions that you |
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include in this declaration will be followed only if a court |
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believes that you are incapacitated to make treatment decisions. |
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Otherwise, you will be considered able to give or withhold consent |
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for the treatments. |
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This document will continue in effect for a period of three |
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years unless you become incapacitated to participate in mental |
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health treatment decisions. If this occurs, the directive will |
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continue in effect until you are no longer incapacitated. |
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You have the right to revoke this document in whole or in part |
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at any time you have not been determined to be incapacitated. YOU |
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MAY NOT REVOKE THIS DECLARATION WHEN YOU ARE CONSIDERED BY A COURT |
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TO BE INCAPACITATED. A revocation is effective when it is |
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communicated to your attending physician or other health care |
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provider. |
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If there is anything in this document that you do not |
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understand, you should ask a lawyer to explain it to you. This |
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declaration is not valid unless it is either acknowledged before a |
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notary public or signed by two qualified witnesses who are |
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personally known to you and who are present when you sign or |
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acknowledge your signature. |
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SECTION 4. The changes in law made by this Act to Sections |
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137.003 and 137.011, Civil Practice and Remedies Code, apply to a |
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declaration for mental health treatment executed on or after the |
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effective date of this Act. A declaration for mental health |
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treatment executed before the effective date of this Act is |
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governed by the law as it existed on the date the declaration for |
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mental health treatment was executed, and the former law is |
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continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2017. |