(a) Acceptance for preliminary examination. In accordance with Texas Health and Safety Code §573.021 and §573.022, a hospital shall accept for a preliminary examination:
  (1) an individual who has been transported to a hospital by peace officer or emergency medical services personnel in accordance with Texas Health and Safety Code §573.001 or §573.012; or
  (2) an individual who is at least 18 years of age or older and who has been transported to the hospital by the individual's guardian of the person in accordance with Texas Health and Safety Code §573.003.
(b) Preliminary examination.
  (1) A physician shall examine the person as soon as possible within 12 hours after the time the person is apprehended by the peace officer or transported for emergency detention by the person's guardian, in accordance with Texas Health and Safety Code §573.021.
  (2) The preliminary examination shall include:
    (A) an assessment for medical stability; and
    (B) a psychiatric examination to determine if the individual meets the criteria described in subsection (c)(1) of this section.
(c) Requirements for emergency detention. A hospital may admit a prospective patient for emergency detention only if:
  (1) in accordance with Texas Health and Safety Code §573.022(a)(2), a physician determines from the preliminary examination that:
    (A) the prospective patient has a mental illness;
    (B) the prospective patient evidences a substantial risk of serious harm to self or others;
    (C) the described risk of harm is imminent unless the prospective patient is immediately detained; and
    (D) emergency detention is the least restrictive means by which the necessary detention may be accomplished;
  (2) in accordance with Texas Health and Safety Code §573.022(a)(3), a physician makes a written statement:
    (A) documenting the determination described in paragraph (1) of this subsection; and
    (B) describing:
      (i) the nature of the prospective patient's mental illness;
      (ii) the risk of harm the individual evidences, demonstrated either by the prospective patient's behavior or by evidence of severe emotional distress and deterioration in the prospective patient's mental condition to the extent that the prospective patient may harm themselves or another; and
      (iii) the detailed information on which the physician based the determination described in paragraph (1) of this subsection;
  (3) based on the determination described in paragraph (1) of this subsection, the physician issues an order admitting the prospective patient for emergency detention; and
  (4) the prospective patient meets the hospital's admission criteria, as required by §568.21 of this subchapter (relating to Admission Criteria).
(d) Release.
  (1) A hospital shall release a prospective patient accepted for a preliminary examination if:
    (A) a preliminary examination of the prospective patient has not been conducted within the time frame described in subsection (b)(1) of this section; or
    (B) in accordance with Texas Health and Safety Code §573.023(a), the prospective patient is not admitted for emergency detention in accordance with subsection (c) of this section on completion of the preliminary examination.
  (2) In accordance with Texas Health and Safety Code §576.007, before releasing a prospective patient who is at least 18 years of age or older, a hospital shall make a reasonable effort to notify the prospective patient's family of the release if the prospective patient grants permission for the notification.
  (3) Before releasing a patient who is younger than 18 years of age, a hospital shall notify the patient's legally authorized representative (LAR) or the LAR's designee of the release.
  (4) Upon release, the hospital may release a minor younger than 18 years of age only to the minor's LAR or the LAR's designee.
  (5) In accordance with Texas Health and Safety Code §573.021(b), a person accepted for a preliminary examination may be detained in custody for not longer than 48 hours after the person was presented to the facility, unless a written order for protective custody is obtained. If the 48-hour period ends on a Saturday, Sunday, legal holiday, or before 4:00 PM on the first succeeding business day, the person may be detained until 4:00 PM on the first succeeding business day. If the 48-hour period ends at a different time, the person may be detained only until 4:00 PM on the day the 48-hour period ends.
(e) Intake. A hospital shall conduct an intake process as soon as possible, but not later than 24 hours after the time a patient is admitted for emergency detention.
  (1) The intake process shall include:
    (A) obtaining, as much as possible, relevant information about the patient, including information about finances, insurance benefits and advance directives; and
    (B) explaining to the patient and their LAR, when applicable, orally and in writing, the patient's rights described in 25 TAC Chapter 404, Subchapter E (concerning Rights of Persons Receiving Mental Health Services), including:
      (i) the hospital's services and treatment as they relate to the patient; and
      (ii) the existence, purpose, telephone number, and address of the protection and advocacy system of the state of Texas, as required by Texas Health and Safety Code §576.008.
  (2) The hospital shall determine whether the patient comprehends the information provided in accordance with paragraph (1)(B) of this subsection. If the hospital determines that the patient comprehends the information, the hospital shall document in the patient's medical record the reasons for such determination. If the hospital determines that the patient does not comprehend the information, the hospital shall:
    (A) repeat the explanation to the patient at reasonable intervals until the patient demonstrates comprehension of the information or is discharged, whichever occurs first; and
    (B) document in the patient's medical record the patient's response to each explanation and whether the patient demonstrated comprehension of the information.

Source Note: The provisions of this §568.23 adopted to be effective May 27, 2021, 46 TexReg 3276