BILL REQ. #:  H-0430.1 



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HOUSE BILL 1071
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State of Washington61st Legislature2009 Regular Session

By Representatives Green, Morrell, Dickerson, and Kenney

Prefiled 01/06/09. Read first time 01/12/09.   Referred to Committee on Health Care & Wellness.



     AN ACT Relating to advanced registered nurse practitioners; and amending RCW 71.05.210, 71.05.230, 71.05.290, 71.05.300, 71.05.360, 71.05.390, 71.05.420, 71.05.630, 71.05.660, 71.06.040, 71.12.540, 71.32.140, 71.32.250, 71.32.260, 71.34.355, 71.34.720, 71.34.730, 71.34.750, and 71.34.770.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 71.05.210 and 2000 c 94 s 6 are each amended to read as follows:
     Each person involuntarily detained and accepted or admitted at an evaluation and treatment facility shall, within twenty-four hours of his or her admission or acceptance at the facility, be examined and evaluated by a licensed physician who may be assisted by a physician assistant according to chapter 18.71A RCW or an advanced registered nurse practitioner according to chapter 18.79 RCW and a mental health professional, and shall receive such treatment and care as his or her condition requires including treatment on an outpatient basis for the period that he or she is detained, except that, beginning twenty-four hours prior to a trial or hearing pursuant to RCW 71.05.215, 71.05.240, 71.05.310, 71.05.320, 71.05.340, or ((71.05.370)) 71.05.217, the individual may refuse psychiatric medications, but may not refuse: (1) Any other medication previously prescribed by a person licensed under Title 18 RCW; or (2) emergency lifesaving treatment, and the individual shall be informed at an appropriate time of his or her right of such refusal. The person shall be detained up to seventy-two hours, if, in the opinion of the professional person in charge of the facility, or his or her professional designee, the person presents a likelihood of serious harm, or is gravely disabled. A person who has been detained for seventy-two hours shall no later than the end of such period be released, unless referred for further care on a voluntary basis, or detained pursuant to court order for further treatment as provided in this chapter.
     If, after examination and evaluation, the mental health professional and licensed physician ((and mental health professional)) or advanced registered nurse practitioner determine that the initial needs of the person would be better served by placement in a chemical dependency treatment facility, then the person shall be referred to an approved treatment program defined under RCW 70.96A.020.
     An evaluation and treatment center admitting or accepting any person pursuant to this chapter whose physical condition reveals the need for hospitalization shall assure that such person is transferred to an appropriate hospital for evaluation or admission for treatment. Notice of such fact shall be given to the court, the designated attorney, and the ((county)) designated mental health professional and the court shall order such continuance in proceedings under this chapter as may be necessary, but in no event may this continuance be more than fourteen days.

Sec. 2   RCW 71.05.230 and 2006 c 333 s 302 are each amended to read as follows:
     A person detained for seventy-two hour evaluation and treatment may be detained for not more than fourteen additional days of involuntary intensive treatment or ninety additional days of a less restrictive alternative to involuntary intensive treatment. There shall be no fee for filing petitions for fourteen days of involuntary intensive treatment. A petition may only be filed if the following conditions are met:
     (1) The professional staff of the agency or facility providing evaluation services has analyzed the person's condition and finds that the condition is caused by mental disorder and either results in a likelihood of serious harm, or results in the detained person being gravely disabled and are prepared to testify those conditions are met; and
     (2) The person has been advised of the need for voluntary treatment and the professional staff of the facility has evidence that he or she has not in good faith volunteered; and
     (3) The facility providing intensive treatment is certified to provide such treatment by the department; and
     (4) The professional staff of the agency or facility or the designated mental health professional has filed a petition for fourteen day involuntary detention or a ninety day less restrictive alternative with the court. The petition must be signed either by:
     (a) Two physicians ((or by));
     (b) One physician and a mental health professional((who));
     (c) Two psychiatric advanced registered nurse practitioners; or
     (d) One psychiatric advanced registered nurse practitioner and a mental health professional. The persons signing the petition must have examined the person. If involuntary detention is sought the petition shall state facts that support the finding that such person, as a result of mental disorder, presents a likelihood of serious harm, or is gravely disabled and that there are no less restrictive alternatives to detention in the best interest of such person or others. The petition shall state specifically that less restrictive alternative treatment was considered and specify why treatment less restrictive than detention is not appropriate. If an involuntary less restrictive alternative is sought, the petition shall state facts that support the finding that such person, as a result of mental disorder, presents a likelihood of serious harm, or is gravely disabled and shall set forth the less restrictive alternative proposed by the facility; and
     (5) A copy of the petition has been served on the detained person, his or her attorney and his or her guardian or conservator, if any, prior to the probable cause hearing; and
     (6) The court at the time the petition was filed and before the probable cause hearing has appointed counsel to represent such person if no other counsel has appeared; and
     (7) The court has ordered a fourteen day involuntary intensive treatment or a ninety day less restrictive alternative treatment after a probable cause hearing has been held pursuant to RCW 71.05.240; and
     (8) At the conclusion of the initial commitment period, the professional staff of the agency or facility or the designated mental health professional may petition for an additional period of either ninety days of less restrictive alternative treatment or ninety days of involuntary intensive treatment as provided in RCW 71.05.290; and
     (9) If the hospital or facility designated to provide outpatient treatment is other than the facility providing involuntary treatment, the outpatient facility so designated has agreed to assume such responsibility.

Sec. 3   RCW 71.05.290 and 2008 c 213 s 7 are each amended to read as follows:
     (1) At any time during a person's fourteen day intensive treatment period, the professional person in charge of a treatment facility or his or her professional designee or the designated mental health professional may petition the superior court for an order requiring such person to undergo an additional period of treatment. Such petition must be based on one or more of the grounds set forth in RCW 71.05.280.
     (2) The petition shall summarize the facts which support the need for further confinement and shall be supported by affidavits signed by:
     (a) Two examining physicians((, or by));
     (b) One examining physician and examining mental health professional;
     (c) Two psychiatric advanced registered nurse practitioners; or
     (d) One psychiatric advanced registered nurse practitioner and a mental health professional. The affidavits shall describe in detail the behavior of the detained person which supports the petition and shall explain what, if any, less restrictive treatments which are alternatives to detention are available to such person, and shall state the willingness of the affiant to testify to such facts in subsequent judicial proceedings under this chapter.
     (3) If a person has been determined to be incompetent pursuant to RCW 10.77.086(4), then the professional person in charge of the treatment facility or his or her professional designee or the designated mental health professional may directly file a petition for one hundred eighty day treatment under RCW 71.05.280(3). No petition for initial detention or fourteen day detention is required before such a petition may be filed.

Sec. 4   RCW 71.05.300 and 2008 c 213 s 8 are each amended to read as follows:
     (1) The petition for ninety day treatment shall be filed with the clerk of the superior court at least three days before expiration of the fourteen-day period of intensive treatment. At the time of filing such petition, the clerk shall set a time for the person to come before the court on the next judicial day after the day of filing unless such appearance is waived by the person's attorney, and the clerk shall notify the designated mental health professional. The designated mental health professional shall immediately notify the person detained, his or her attorney, if any, and his or her guardian or conservator, if any, the prosecuting attorney, and the regional support network administrator, and provide a copy of the petition to such persons as soon as possible. The regional support network administrator or designee may review the petition and may appear and testify at the full hearing on the petition.
     (2) At the time set for appearance the detained person shall be brought before the court, unless such appearance has been waived and the court shall advise him or her of his or her right to be represented by an attorney and of his or her right to a jury trial. If the detained person is not represented by an attorney, or is indigent or is unwilling to retain an attorney, the court shall immediately appoint an attorney to represent him or her. The court shall, if requested, appoint a reasonably available licensed physician, advanced registered nurse practitioner, psychologist, or psychiatrist, designated by the detained person to examine and testify on behalf of the detained person.
     (3) The court may, if requested, also appoint a professional person as defined in RCW 71.05.020 to seek less restrictive alternative courses of treatment and to testify on behalf of the detained person. In the case of a person with a developmental disability who has been determined to be incompetent pursuant to RCW 10.77.086(4), then the appointed professional person under this section shall be a developmental disabilities professional.
     (4) The court shall also set a date for a full hearing on the petition as provided in RCW 71.05.310.

Sec. 5   RCW 71.05.360 and 2007 c 375 s 14 are each amended to read as follows:
     (1)(a) Every person involuntarily detained or committed under the provisions of this chapter shall be entitled to all the rights set forth in this chapter, which shall be prominently posted in the facility, and shall retain all rights not denied him or her under this chapter except as chapter 9.41 RCW may limit the right of a person to purchase or possess a firearm or to qualify for a concealed pistol license.
     (b) No person shall be presumed incompetent as a consequence of receiving an evaluation or voluntary or involuntary treatment for a mental disorder, under this chapter or any prior laws of this state dealing with mental illness. Competency shall not be determined or withdrawn except under the provisions of chapter 10.77 or 11.88 RCW.
     (c) Any person who leaves a public or private agency following evaluation or treatment for mental disorder shall be given a written statement setting forth the substance of this section.
     (2) Each person involuntarily detained or committed pursuant to this chapter shall have the right to adequate care and individualized treatment.
     (3) The provisions of this chapter shall not be construed to deny to any person treatment by spiritual means through prayer in accordance with the tenets and practices of a church or religious denomination.
     (4) Persons receiving evaluation or treatment under this chapter shall be given a reasonable choice of an available physician, advanced registered nurse practitioner, or other professional person qualified to provide such services.
     (5) Whenever any person is detained for evaluation and treatment pursuant to this chapter, both the person and, if possible, a responsible member of his or her immediate family, personal representative, guardian, or conservator, if any, shall be advised as soon as possible in writing or orally, by the officer or person taking him or her into custody or by personnel of the evaluation and treatment facility where the person is detained that unless the person is released or voluntarily admits himself or herself for treatment within seventy-two hours of the initial detention:
     (a) A judicial hearing in a superior court, either by a judge or court commissioner thereof, shall be held not more than seventy-two hours after the initial detention to determine whether there is probable cause to detain the person after the seventy-two hours have expired for up to an additional fourteen days without further automatic hearing for the reason that the person is a person whose mental disorder presents a likelihood of serious harm or that the person is gravely disabled;
     (b) The person has a right to communicate immediately with an attorney; has a right to have an attorney appointed to represent him or her before and at the probable cause hearing if he or she is indigent; and has the right to be told the name and address of the attorney that the mental health professional has designated pursuant to this chapter;
     (c) The person has the right to remain silent and that any statement he or she makes may be used against him or her;
     (d) The person has the right to present evidence and to cross-examine witnesses who testify against him or her at the probable cause hearing; and
     (e) The person has the right to refuse psychiatric medications, including antipsychotic medication beginning twenty-four hours prior to the probable cause hearing.
     (6) When proceedings are initiated under RCW 71.05.153, no later than twelve hours after such person is admitted to the evaluation and treatment facility the personnel of the evaluation and treatment facility or the designated mental health professional shall serve on such person a copy of the petition for initial detention and the name, business address, and phone number of the designated attorney and shall forthwith commence service of a copy of the petition for initial detention on the designated attorney.
     (7) The judicial hearing described in subsection (5) of this section is hereby authorized, and shall be held according to the provisions of subsection (5) of this section and rules promulgated by the supreme court.
     (8) At the probable cause hearing the detained person shall have the following rights in addition to the rights previously specified:
     (a) To present evidence on his or her behalf;
     (b) To cross-examine witnesses who testify against him or her;
     (c) To be proceeded against by the rules of evidence;
     (d) To remain silent;
     (e) To view and copy all petitions and reports in the court file.
     (9) ((The physician-patient privilege or the psychologist-client privilege shall be)) Privileges between patients and physicians, psychologists, or nursing staff are deemed waived in proceedings under this chapter relating to the administration of antipsychotic medications. As to other proceedings under this chapter, the privileges shall be waived when a court of competent jurisdiction in its discretion determines that such waiver is necessary to protect either the detained person or the public.
     The waiver of a privilege under this section is limited to records or testimony relevant to evaluation of the detained person for purposes of a proceeding under this chapter. Upon motion by the detained person or on its own motion, the court shall examine a record or testimony sought by a petitioner to determine whether it is within the scope of the waiver.
     The record maker shall not be required to testify in order to introduce medical or psychological records of the detained person so long as the requirements of RCW 5.45.020 are met except that portions of the record which contain opinions as to the detained person's mental state must be deleted from such records unless the person making such conclusions is available for cross-examination.
     (10) Insofar as danger to the person or others is not created, each person involuntarily detained, treated in a less restrictive alternative course of treatment, or committed for treatment and evaluation pursuant to this chapter shall have, in addition to other rights not specifically withheld by law, the following rights:
     (a) To wear his or her own clothes and to keep and use his or her own personal possessions, except when deprivation of same is essential to protect the safety of the resident or other persons;
     (b) To keep and be allowed to spend a reasonable sum of his or her own money for canteen expenses and small purchases;
     (c) To have access to individual storage space for his or her private use;
     (d) To have visitors at reasonable times;
     (e) To have reasonable access to a telephone, both to make and receive confidential calls, consistent with an effective treatment program;
     (f) To have ready access to letter writing materials, including stamps, and to send and receive uncensored correspondence through the mails;
     (g) To discuss treatment plans and decisions with professional persons;
     (h) Not to consent to the administration of antipsychotic medications and not to thereafter be administered antipsychotic medications unless ordered by a court under RCW 71.05.217 or pursuant to an administrative hearing under RCW 71.05.215;
     (i) Not to consent to the performance of electroconvulsant therapy or surgery, except emergency life-saving surgery, unless ordered by a court under RCW 71.05.217;
     (j) Not to have psychosurgery performed on him or her under any circumstances;
     (k) To dispose of property and sign contracts unless such person has been adjudicated an incompetent in a court proceeding directed to that particular issue.
     (11) Every person involuntarily detained shall immediately be informed of his or her right to a hearing to review the legality of his or her detention and of his or her right to counsel, by the professional person in charge of the facility providing evaluation and treatment, or his or her designee, and, when appropriate, by the court. If the person so elects, the court shall immediately appoint an attorney to assist him or her.
     (12) A person challenging his or her detention or his or her attorney shall have the right to designate and have the court appoint a reasonably available independent physician, advanced registered nurse practitioner, or licensed mental health professional to examine the person detained, the results of which examination may be used in the proceeding. The person shall, if he or she is financially able, bear the cost of such expert examination, otherwise such expert examination shall be at public expense.
     (13) Nothing contained in this chapter shall prohibit the patient from petitioning by writ of habeas corpus for release.
     (14) Nothing in this chapter shall prohibit a person committed on or prior to January 1, 1974, from exercising a right available to him or her at or prior to January 1, 1974, for obtaining release from confinement.
     (15) Nothing in this section permits any person to knowingly violate a no-contact order or a condition of an active judgment and sentence or an active condition of supervision by the department of corrections.

Sec. 6   RCW 71.05.390 and 2007 c 375 s 15 are each amended to read as follows:
     Except as provided in this section, RCW 71.05.445, 71.05.630, 70.96A.150, or pursuant to a valid release under RCW 70.02.030, the fact of admission and all information and records compiled, obtained, or maintained in the course of providing services to either voluntary or involuntary recipients of services at public or private agencies shall be confidential.
     Information and records may be disclosed only:
     (1) In communications between qualified professional persons to meet the requirements of this chapter, in the provision of services or appropriate referrals, or in the course of guardianship proceedings. The consent of the person, or his or her personal representative or guardian, shall be obtained before information or records may be disclosed by a professional person employed by a facility unless provided to a professional person:
     (a) Employed by the facility;
     (b) Who has medical responsibility for the patient's care;
     (c) Who is a designated mental health professional;
     (d) Who is providing services under chapter 71.24 RCW;
     (e) Who is employed by a state or local correctional facility where the person is confined or supervised; or
     (f) Who is providing evaluation, treatment, or follow-up services under chapter 10.77 RCW.
     (2) When the communications regard the special needs of a patient and the necessary circumstances giving rise to such needs and the disclosure is made by a facility providing services to the operator of a facility in which the patient resides or will reside.
     (3)(a) When the person receiving services, or his or her guardian, designates persons to whom information or records may be released, or if the person is a minor, when his or her parents make such designation.
     (b) A public or private agency shall release to a person's next of kin, attorney, personal representative, guardian, or conservator, if any:
     (i) The information that the person is presently a patient in the facility or that the person is seriously physically ill;
     (ii) A statement evaluating the mental and physical condition of the patient, and a statement of the probable duration of the patient's confinement, if such information is requested by the next of kin, attorney, personal representative, guardian, or conservator; and
     (iii) Such other information requested by the next of kin or attorney as may be necessary to decide whether or not proceedings should be instituted to appoint a guardian or conservator.
     (4) To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
     (5)(a) For either program evaluation or research, or both: PROVIDED, That the secretary adopts rules for the conduct of the evaluation or research, or both. Such rules shall include, but need not be limited to, the requirement that all evaluators and researchers must sign an oath of confidentiality substantially as follows:

     "As a condition of conducting evaluation or research concerning persons who have received services from (fill in the facility, agency, or person) I, . . . . . . . . ., agree not to divulge, publish, or otherwise make known to unauthorized persons or the public any information obtained in the course of such evaluation or research regarding persons who have received services such that the person who received such services is identifiable.
     I recognize that unauthorized release of confidential information may subject me to civil liability under the provisions of state law.


 /s/ . . . . . . . . . . . . "

     (b) Nothing in this chapter shall be construed to prohibit the compilation and publication of statistical data for use by government or researchers under standards, including standards to assure maintenance of confidentiality, set forth by the secretary.
     (6)(a) To the courts as necessary to the administration of this chapter or to a court ordering an evaluation or treatment under chapter 10.77 RCW solely for the purpose of preventing the entry of any evaluation or treatment order that is inconsistent with any order entered under this chapter.
     (b) To a court or its designee in which a motion under chapter 10.77 RCW has been made for involuntary medication of a defendant for the purpose of competency restoration.
     (c) Disclosure under this subsection is mandatory for the purpose of the health insurance portability and accountability act.
     (7)(a) When a mental health professional is requested by a representative of a law enforcement or corrections agency, including a police officer, sheriff, community corrections officer, a municipal attorney, or prosecuting attorney to undertake an investigation or provide treatment under RCW 71.05.150, 10.31.110, or 71.05.153, the mental health professional shall, if requested to do so, advise the representative in writing of the results of the investigation including a statement of reasons for the decision to detain or release the person investigated. Such written report shall be submitted within seventy-two hours of the completion of the investigation or the request from the law enforcement or corrections representative, whichever occurs later.
     (b) To law enforcement officers, public health officers, or personnel of the department of corrections or the indeterminate sentence review board for persons who are the subject of the records and who are committed to the custody or supervision of the department of corrections or indeterminate sentence review board which information or records are necessary to carry out the responsibilities of their office. Except for dissemination of information released pursuant to RCW 71.05.425 and 4.24.550, regarding persons committed under this chapter under RCW 71.05.280(3) and 71.05.320(3)(c) after dismissal of a sex offense as defined in RCW 9.94A.030, the extent of information that may be released is limited as follows:
     (i) Only the fact, place, and date of involuntary commitment, the fact and date of discharge or release, and the last known address shall be disclosed upon request;
     (ii) The law enforcement and public health officers or personnel of the department of corrections or indeterminate sentence review board shall be obligated to keep such information confidential in accordance with this chapter;
     (iii) Additional information shall be disclosed only after giving notice to said person and his or her counsel and upon a showing of clear, cogent, and convincing evidence that such information is necessary and that appropriate safeguards for strict confidentiality are and will be maintained. However, in the event the said person has escaped from custody, said notice prior to disclosure is not necessary and that the facility from which the person escaped shall include an evaluation as to whether the person is of danger to persons or property and has a propensity toward violence;
     (iv) Information and records shall be disclosed to the department of corrections pursuant to and in compliance with the provisions of RCW 71.05.445 for the purposes of completing presentence investigations or risk assessment reports, supervision of an incarcerated offender or offender under supervision in the community, planning for and provision of supervision of an offender, or assessment of an offender's risk to the community; and
     (v) Disclosure under this subsection is mandatory for the purposes of the health insurance portability and accountability act.
     (8) To the attorney of the detained person.
     (9) To the prosecuting attorney as necessary to carry out the responsibilities of the office under RCW 71.05.330(2) and 71.05.340(1)(b) and 71.05.335. The prosecutor shall be provided access to records regarding the committed person's treatment and prognosis, medication, behavior problems, and other records relevant to the issue of whether treatment less restrictive than inpatient treatment is in the best interest of the committed person or others. Information shall be disclosed only after giving notice to the committed person and the person's counsel.
     (10) To appropriate law enforcement agencies and to a person, when the identity of the person is known to the public or private agency, whose health and safety has been threatened, or who is known to have been repeatedly harassed, by the patient. The person may designate a representative to receive the disclosure. The disclosure shall be made by the professional person in charge of the public or private agency or his or her designee and shall include the dates of commitment, admission, discharge, or release, authorized or unauthorized absence from the agency's facility, and only such other information that is pertinent to the threat or harassment. The decision to disclose or not shall not result in civil liability for the agency or its employees so long as the decision was reached in good faith and without gross negligence.
     (11) To appropriate corrections and law enforcement agencies all necessary and relevant information in the event of a crisis or emergent situation that poses a significant and imminent risk to the public. The decision to disclose or not shall not result in civil liability for the mental health service provider or its employees so long as the decision was reached in good faith and without gross negligence.
     (12) To the persons designated in RCW 71.05.425 for the purposes described in that section.
     (13) Civil liability and immunity for the release of information about a particular person who is committed to the department under RCW 71.05.280(3) and 71.05.320(3)(c) after dismissal of a sex offense as defined in RCW 9.94A.030, is governed by RCW 4.24.550.
     (14) Upon the death of a person, his or her next of kin, personal representative, guardian, or conservator, if any, shall be notified.
     Next of kin who are of legal age and competent shall be notified under this section in the following order: Spouse, parents, children, brothers and sisters, and other relatives according to the degree of relation. Access to all records and information compiled, obtained, or maintained in the course of providing services to a deceased patient shall be governed by RCW 70.02.140.
     (15) To the department of health for the purposes of determining compliance with state or federal licensure, certification, or registration rules or laws. However, the information and records obtained under this subsection are exempt from public inspection and copying pursuant to chapter 42.56 RCW.
     (16) To mark headstones or otherwise memorialize patients interred at state hospital cemeteries. The department of social and health services shall make available the name, date of birth, and date of death of patients buried in state hospital cemeteries fifty years after the death of a patient.
     (17) To law enforcement officers and to prosecuting attorneys as are necessary to enforce RCW 9.41.040(2)(a)(ii). The extent of information that may be released is limited as follows:
     (a) Only the fact, place, and date of involuntary commitment, an official copy of any order or orders of commitment, and an official copy of any written or oral notice of ineligibility to possess a firearm that was provided to the person pursuant to RCW 9.41.047(1), shall be disclosed upon request;
     (b) The law enforcement and prosecuting attorneys may only release the information obtained to the person's attorney as required by court rule and to a jury or judge, if a jury is waived, that presides over any trial at which the person is charged with violating RCW 9.41.040(2)(a)(ii);
     (c) Disclosure under this subsection is mandatory for the purposes of the health insurance portability and accountability act.
     (18) When a patient would otherwise be subject to the provisions of RCW 71.05.390 and disclosure is necessary for the protection of the patient or others due to his or her unauthorized disappearance from the facility, and his or her whereabouts is unknown, notice of such disappearance, along with relevant information, may be made to relatives, the department of corrections when the person is under the supervision of the department, and governmental law enforcement agencies designated by the physician or advanced registered nurse practitioner in charge of the patient or the professional person in charge of the facility, or his or her professional designee.
     Except as otherwise provided in this chapter, the uniform health care information act, chapter 70.02 RCW, applies to all records and information compiled, obtained, or maintained in the course of providing services.
     (19) The fact of admission, as well as all records, files, evidence, findings, or orders made, prepared, collected, or maintained pursuant to this chapter shall not be admissible as evidence in any legal proceeding outside this chapter without the written consent of the person who was the subject of the proceeding except in a subsequent criminal prosecution of a person committed pursuant to RCW 71.05.280(3) or 71.05.320(3)(c) on charges that were dismissed pursuant to chapter 10.77 RCW due to incompetency to stand trial, in a civil commitment proceeding pursuant to chapter 71.09 RCW, or, in the case of a minor, a guardianship or dependency proceeding. The records and files maintained in any court proceeding pursuant to this chapter shall be confidential and available subsequent to such proceedings only to the person who was the subject of the proceeding or his or her attorney. In addition, the court may order the subsequent release or use of such records or files only upon good cause shown if the court finds that appropriate safeguards for strict confidentiality are and will be maintained.

Sec. 7   RCW 71.05.420 and 2005 c 504 s 110 are each amended to read as follows:
     Except as provided in RCW 71.05.425, when any disclosure of information or records is made as authorized by RCW 71.05.390, the physician or advanced registered nurse practitioner in charge of the patient or the professional person in charge of the facility shall promptly cause to be entered into the patient's medical record the date and circumstances under which said disclosure was made, the names and relationships to the patient, if any, of the persons or agencies to whom such disclosure was made, and the information disclosed.

Sec. 8   RCW 71.05.630 and 2007 c 191 s 1 are each amended to read as follows:
     (1) Except as otherwise provided by law, all treatment records shall remain confidential and may be released only to the persons designated in this section, or to other persons designated in an informed written consent of the patient.
     (2) Treatment records of a person may be released without informed written consent in the following circumstances:
     (a) To a person, organization, or agency as necessary for management or financial audits, or program monitoring and evaluation. Information obtained under this subsection shall remain confidential and may not be used in a manner that discloses the name or other identifying information about the person whose records are being released.
     (b) To the department, the director of regional support networks, or a qualified staff member designated by the director only when necessary to be used for billing or collection purposes. The information shall remain confidential.
     (c) For purposes of research as permitted in chapter 42.48 RCW.
     (d) Pursuant to lawful order of a court.
     (e) To qualified staff members of the department, to the director of regional support networks, to resource management services responsible for serving a patient, or to service providers designated by resource management services as necessary to determine the progress and adequacy of treatment and to determine whether the person should be transferred to a less restrictive or more appropriate treatment modality or facility. The information shall remain confidential.
     (f) Within the treatment facility where the patient is receiving treatment, confidential information may be disclosed to persons employed, serving in bona fide training programs, or participating in supervised volunteer programs, at the facility when it is necessary to perform their duties.
     (g) Within the department as necessary to coordinate treatment for mental illness, developmental disabilities, alcoholism, or drug abuse of persons who are under the supervision of the department.
     (h) To a licensed physician or advanced registered nurse practitioner who has determined that the life or health of the person is in danger and that treatment without the information contained in the treatment records could be injurious to the patient's health. Disclosure shall be limited to the portions of the records necessary to meet the medical emergency.
     (i) To a facility that is to receive a person who is involuntarily committed under chapter 71.05 RCW, or upon transfer of the person from one treatment facility to another. The release of records under this subsection shall be limited to the treatment records required by law, a record or summary of all somatic treatments, and a discharge summary. The discharge summary may include a statement of the patient's problem, the treatment goals, the type of treatment which has been provided, and recommendation for future treatment, but may not include the patient's complete treatment record.
     (j) Notwithstanding the provisions of RCW 71.05.390(7), to a correctional facility or a corrections officer who is responsible for the supervision of a person who is receiving inpatient or outpatient evaluation or treatment. Except as provided in RCW 71.05.445 and 71.34.345, release of records under this section is limited to:
     (i) An evaluation report provided pursuant to a written supervision plan.
     (ii) The discharge summary, including a record or summary of all somatic treatments, at the termination of any treatment provided as part of the supervision plan.
     (iii) When a person is returned from a treatment facility to a correctional facility, the information provided under (j)(iv) of this subsection.
     (iv) Any information necessary to establish or implement changes in the person's treatment plan or the level or kind of supervision as determined by resource management services. In cases involving a person transferred back to a correctional facility, disclosure shall be made to clinical staff only.
     (k) To the person's counsel or guardian ad litem, without modification, at any time in order to prepare for involuntary commitment or recommitment proceedings, reexaminations, appeals, or other actions relating to detention, admission, commitment, or patient's rights under chapter 71.05 RCW.
     (l) To staff members of the protection and advocacy agency or to staff members of a private, nonprofit corporation for the purpose of protecting and advocating the rights of persons with mental disorders or developmental disabilities. Resource management services may limit the release of information to the name, birthdate, and county of residence of the patient, information regarding whether the patient was voluntarily admitted, or involuntarily committed, the date and place of admission, placement, or commitment, the name and address of a guardian of the patient, and the date and place of the guardian's appointment. Any staff member who wishes to obtain additional information shall notify the patient's resource management services in writing of the request and of the resource management services' right to object. The staff member shall send the notice by mail to the guardian's address. If the guardian does not object in writing within fifteen days after the notice is mailed, the staff member may obtain the additional information. If the guardian objects in writing within fifteen days after the notice is mailed, the staff member may not obtain the additional information.
     (m) For purposes of coordinating health care, the department may release without informed written consent of the patient, information acquired for billing and collection purposes as described in (b) of this subsection to all current treating providers of the patient with prescriptive authority who have written a prescription for the patient within the last twelve months. The department shall notify the patient that billing and collection information has been released to named providers, and provide the substance of the information released and the dates of such release. The department shall not release counseling, inpatient psychiatric hospitalization, or drug and alcohol treatment information without a signed written release from the client.
     (3) Whenever federal law or federal regulations restrict the release of information contained in the treatment records of any patient who receives treatment for chemical dependency, the department may restrict the release of the information as necessary to comply with federal law and regulations.

Sec. 9   RCW 71.05.660 and 2005 c 504 s 114 are each amended to read as follows:
     Nothing in this chapter or chapter 70.96A, 71.05, 71.34, or 70.96B RCW shall be construed to interfere with communications between physicians, advanced registered nurse practitioners, or psychologists and patients and attorneys and clients.

Sec. 10   RCW 71.06.040 and 1959 c 25 s 71.06.040 are each amended to read as follows:
     At a preliminary hearing upon the charge of sexual psychopathy, the court may require the testimony of two duly licensed physicians or advanced registered nurse practitioners who have examined the defendant. If the court finds that there are reasonable grounds to believe the defendant is a sexual psychopath, the court shall order said defendant confined at the nearest state hospital for observation as to the existence of sexual psychopathy. Such observation shall be for a period of not to exceed ninety days. The defendant shall be detained in the county jail or other county facilities pending execution of such observation order by the department.

Sec. 11   RCW 71.12.540 and 1989 1st ex.s. c 9 s 233 are each amended to read as follows:
     The authorities of each establishment as defined in this chapter shall place on file in the office of the establishment the recommendations made by the department of health as a result of such visits, for the purpose of consultation by such authorities, and for reference by the department representatives upon their visits. Every such establishment shall keep records of every person admitted thereto as follows and shall furnish to the department, when required, the following data: Name, age, sex, marital status, date of admission, voluntary or other commitment, name of physician or advanced registered nurse practitioner, diagnosis, and date of discharge.

Sec. 12   RCW 71.32.140 and 2004 c 39 s 2 are each amended to read as follows:
     (1) A principal who:
     (a) Chose not to be able to revoke his or her directive during any period of incapacity;
     (b) Consented to voluntary admission to inpatient mental health treatment, or authorized an agent to consent on the principal's behalf; and
     (c) At the time of admission to inpatient treatment, refuses to be admitted,
may only be admitted into inpatient mental health treatment under subsection (2) of this section.
     (2) A principal may only be admitted to inpatient mental health treatment under his or her directive if, prior to admission, a ((physician)) member of the treating facility's professional staff who is a physician or advanced registered nurse practitioner:
     (a) Evaluates the principal's mental condition, including a review of reasonably available psychiatric and psychological history, diagnosis, and treatment needs, and determines, in conjunction with another health care provider or mental health professional, that the principal is incapacitated;
     (b) Obtains the informed consent of the agent, if any, designated in the directive;
     (c) Makes a written determination that the principal needs an inpatient evaluation or is in need of inpatient treatment and that the evaluation or treatment cannot be accomplished in a less restrictive setting; and
     (d) Documents in the principal's medical record a summary of the physician's or advanced registered nurse practitioner's findings and recommendations for treatment or evaluation.
     (3) In the event the admitting physician is not a psychiatrist, or the advanced registered nurse practitioner is not a psychiatric advanced registered nurse practitioner, the principal shall receive a complete psychological assessment by a mental health professional within twenty-four hours of admission to determine the continued need for inpatient evaluation or treatment.
     (4)(a) If it is determined that the principal has capacity, then the principal may only be admitted to, or remain in, inpatient treatment if he or she consents at the time or is detained under the involuntary treatment provisions of chapter 70.96A, 71.05, or 71.34 RCW.
     (b) If a principal who is determined by two health care providers or one mental health professional and one health care provider to be incapacitated continues to refuse inpatient treatment, the principal may immediately seek injunctive relief for release from the facility.
     (5) If, at the end of the period of time that the principal or the principal's agent, if any, has consented to voluntary inpatient treatment, but no more than fourteen days after admission, the principal has not regained capacity or has regained capacity but refuses to consent to remain for additional treatment, the principal must be released during reasonable daylight hours, unless detained under chapter 70.96A, 71.05, or 71.34 RCW.
     (6)(a) Except as provided in (b) of this subsection, any principal who is voluntarily admitted to inpatient mental health treatment under this chapter shall have all the rights provided to individuals who are voluntarily admitted to inpatient treatment under chapter 71.05, 71.34, or 72.23 RCW.
     (b) Notwithstanding RCW 71.05.050 regarding consent to inpatient treatment for a specified length of time, the choices an incapacitated principal expressed in his or her directive shall control, provided, however, that a principal who takes action demonstrating a desire to be discharged, in addition to making statements requesting to be discharged, shall be discharged, and no principal shall be restrained in any way in order to prevent his or her discharge. Nothing in this subsection shall be construed to prevent detention and evaluation for civil commitment under chapter 71.05 RCW.
     (7) Consent to inpatient admission in a directive is effective only while the professional person, health care provider, and health care facility are in substantial compliance with the material provisions of the directive related to inpatient treatment.

Sec. 13   RCW 71.32.250 and 2003 c 283 s 25 are each amended to read as follows:
     (1) If a principal who is a resident of a long-term care facility is admitted to inpatient mental health treatment pursuant to his or her directive, the principal shall be allowed to be readmitted to the same long-term care facility as if his or her inpatient admission had been for a physical condition on the same basis that the principal would be readmitted under state or federal statute or rule when:
     (a) The treating facility's professional staff determine that inpatient mental health treatment is no longer medically necessary for the resident. The determination shall be made in writing (i) by a psychiatrist or (ii) by a mental health professional and either (A) a physician or (B) advanced registered nurse practitioner; or
     (b) The person's consent to admission in his or her directive has expired.
     (2)(a) If the long-term care facility does not have a bed available at the time of discharge, the treating facility may discharge the resident, in consultation with the resident and agent if any, and in accordance with a medically appropriate discharge plan, to another long-term care facility.
     (b) This section shall apply to inpatient mental health treatment admission of long-term care facility residents, regardless of whether the admission is directly from a facility, hospital emergency room, or other location.
     (c) This section does not restrict the right of the resident to an earlier release from the inpatient treatment facility. This section does not restrict the right of a long-term care facility to initiate transfer or discharge of a resident who is readmitted pursuant to this section, provided that the facility has complied with the laws governing the transfer or discharge of a resident.
     (3) The joint legislative audit and review committee shall conduct an evaluation of the operation and impact of this section. The committee shall report its findings to the appropriate committees of the legislature by December 1, 2004.

Sec. 14   RCW 71.32.260 and 2003 c 283 s 26 are each amended to read as follows:
     The directive shall be in substantially the following form:

Mental Health Advance Directive
NOTICE TO PERSONS
CREATING A MENTAL HEALTH ADVANCE DIRECTIVE
This is an important legal document. It creates an advance directive for mental health treatment. Before signing this document you should know these important facts:
(1) This document is called an advance directive and allows you to make decisions in advance about your mental health      treatment, including medications, short-term admission to inpatient treatment and electroconvulsive therapy.
YOU DO NOT HAVE TO FILL OUT OR SIGN THIS FORM.
IF YOU DO NOT SIGN THIS FORM, IT WILL NOT TAKE EFFECT.
     If you choose to complete and sign this document, you may still decide to leave some items blank.
(2) You have the right to appoint a person as your agent to make treatment decisions for you. You must notify your      agent that you have appointed him or her as an agent. The person you appoint has a duty to act consistently with      your wishes made known by you. If your agent does not know what your wishes are, he or she has a duty to act in      your best interest. Your agent has the right to withdraw from the appointment at any time.
(3) The instructions you include with this advance directive and the authority you give your agent to act will only become      effective under the conditions you select in this document. You may choose to limit this directive and your agent's      authority to times when you are incapacitated or to times when you are exhibiting symptoms or behavior that you      specify. You may also make this directive effective immediately. No matter when you choose to make this directive      effective, your treatment providers must still seek your informed consent at all times that you have capacity to give      informed consent.
(4) You have the right to revoke this document in writing at any time you have capacity.
     YOU MAY NOT REVOKE THIS DIRECTIVE WHEN YOU HAVE BEEN FOUND TO BE
     INCAPACITATED UNLESS YOU HAVE SPECIFICALLY STATED IN THIS DIRECTIVE THAT
     YOU WANT IT TO BE REVOCABLE WHEN YOU ARE INCAPACITATED.
(5) This directive will stay in effect until you revoke it unless you specify an expiration date. If you specify an expiration      date and you are incapacitated at the time it expires, it will remain in effect until you have capacity to make      treatment decisions again unless you chose to be able to revoke it while you are incapacitated and you revoke the      directive.
(6) You cannot use your advance directive to consent to civil commitment. The procedures that apply to your advance      directive are different than those provided for in the Involuntary Treatment Act. Involuntary treatment is a different      process.
(7) If there is anything in this directive that you do not understand, you should ask a lawyer to explain it to you.
(8) You should be aware that there are some circumstances where your provider may not have to follow your directive.
(9) You should discuss any treatment decisions in your directive with your provider.
(10) You may ask the court to rule on the validity of your directive.

PART I.
STATEMENT OF INTENT TO CREATE A
MENTAL HEALTH ADVANCE DIRECTIVE
     I, . . . . . . . . . . being a person with capacity, willfully and voluntarily execute this mental health advance directive so that my choices regarding my mental health care will be carried out in circumstances when I am unable to express my instructions and preferences regarding my mental health care. If a guardian is appointed by a court to make mental health decisions for me, I intend this document to take precedence over all other means of ascertaining my intent.
     The fact that I may have left blanks in this directive does not affect its validity in any way. I intend that all completed sections be followed. If I have not expressed a choice, my agent should make the decision that he or she determines is in my best interest. I intend this directive to take precedence over any other directives I have previously executed, to the extent that they are inconsistent with this document, or unless I expressly state otherwise in either document.
     I understand that I may revoke this directive in whole or in part if I am a person with capacity. I understand that I cannot revoke this directive if a court, two health care providers, or one mental health professional and one health care provider find that I am an incapacitated person, unless, when I executed this directive, I chose to be able to revoke this directive while incapacitated.
     I understand that, except as otherwise provided in law, revocation must be in writing. I understand that nothing in this directive, or in my refusal of treatment to which I consent in this directive, authorizes any health care provider, professional person, health care facility, or agent appointed in this directive to use or threaten to use abuse, neglect, financial exploitation, or abandonment to carry out my directive.
     I understand that there are some circumstances where my provider may not have to follow my directive.

PART II.
WHEN THIS DIRECTIVE IS EFFECTIVE
YOU MUST COMPLETE THIS PART FOR YOUR DIRECTIVE TO BE VALID.
I intend that this directive become effective (YOU MUST CHOOSE ONLY ONE):
. . . . . . Immediately upon my signing of this directive.
. . . . . . If I become incapacitated.
. . . . . . When the following circumstances, symptoms, or behaviors occur: . . . . . . . . . . . .
. . . . . . . . . . . .
. . . . . . . . . . . .

PART III.
DURATION OF THIS DIRECTIVE
YOU MUST COMPLETE THIS PART FOR YOUR DIRECTIVE TO BE VALID.
I want this directive to (YOU MUST CHOOSE ONLY ONE):
. . . . . . Remain valid and in effect for an indefinite period of time.
. . . . . . Automatically expire . . . . . . years from the date it was created.

PART IV.
WHEN I MAY REVOKE THIS DIRECTIVE
YOU MUST COMPLETE THIS PART FOR THIS DIRECTIVE TO BE VALID.
I intend that I be able to revoke this directive (YOU MUST CHOOSE ONLY ONE):
. . . . . . Only when I have capacity.
     I understand that choosing this option means I may only revoke this directive if I have capacity. I further understand      that if I choose this option and become incapacitated while this directive is in effect, I may receive treatment      that I specify in this directive, even if I object at the time.
. . . . . . Even if I am incapacitated.
     I understand that choosing this option means that I may revoke this directive even if I am incapacitated. I further      understand that if I choose this option and revoke this directive while I am incapacitated I may not receive      treatment that I specify in this directive, even if I want the treatment.

PART V.
PREFERENCES AND INSTRUCTIONS ABOUT TREATMENT, FACILITIES, AND PHYSICIANS OR ADVANCED REGISTERED NURSE PRACTITIONERS
A. Preferences and Instructions About Physician(s) or Advanced Registered Nurse Practitioner(s) to be Involved in My Treatment
I would like the physician(s) or advanced registered nurse practitioner(s) named below to be involved in my treatment decisions:
Dr. or ARNP . . . . . . . . . . . . . . . . Contact information: . . . . . . . . . . . .
Dr. or ARNP . . . . . . . . . . . . . . . . Contact information: . . . . . . . . . . . .
I do not wish to be treated by Dr. or ARNP . . . . . . . . . . . .
B. Preferences and Instructions About Other Providers
I am receiving other treatment or care from providers who I feel have an impact on my mental health care. I would like the following treatment provider(s) to be contacted when this directive is effective:
Name . . . . . . . . . . . . . . . . . . . . Profession . . . . . . . . . . . . . . . . . . . . Contact information . . . . . . . . . . . .
Name . . . . . . . . . . . . . . . . . . . . Profession . . . . . . . . . . . . . . . . . . . . Contact information . . . . . . . . . . . .
C. Preferences and Instructions About Medications for Psychiatric Treatment (initial and complete all that apply)
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the following
medications: . . . . . . . . . . . .
. . . . . . I do not consent, and I do not authorize my agent (if appointed) to consent, to the administration of the following medications: . . . . . . . . . . . .
. . . . . . I am willing to take the medications excluded above if my only reason for excluding them is the side effects which include . . . . . . . . . . . .
and these side effects can be eliminated by dosage adjustment or other means
. . . . . . I am willing to try any other medication the hospital doctor or advanced registered nurse practitioner recommends
. . . . . . I am willing to try any other medications my outpatient doctor or advanced registered nurse practitioner recommends
. . . . . . I do not want to try any other medications.
Medication Allergies
I have allergies to, or severe side effects from, the following: . . . . . . . . . . . .
. . . . . . . . . . . .
Other Medication Preferences or Instructions
. . . . . . I have the following other preferences or instructions about medications . . . . . . . . . . . .
. . . . . . . . . . . .
D. Preferences and Instructions About Hospitalization and Alternatives
(initial all that apply and, if desired, rank "1" for first choice, "2" for second choice, and so on)
. . . . . . In the event my psychiatric condition is serious enough to require 24-hour care and I have no physical conditions that require immediate access to emergency medical care, I prefer to receive this care in programs/facilities designed as alternatives to psychiatric hospitalizations.
. . . . . . I would also like the interventions below to be tried before hospitalization is considered:
. . . . . . Calling someone or having someone call me when needed.
     Name: . . . . . . . . . . . . Telephone: . . . . . . . . . . . .
. . . . . . Staying overnight with someone
     Name: . . . . . . . . . . . . Telephone: . . . . . . . . . . . .
. . . . . . Having a mental health service provider come to see me
. . . . . . Going to a crisis triage center or emergency room
. . . . . . Staying overnight at a crisis respite (temporary) bed
. . . . . . Seeing a service provider for help with psychiatric medications
. . . . . . Other, specify: . . . . . . . . . . . .
Authority to Consent to Inpatient Treatment
I consent, and authorize my agent (if appointed) to consent, to voluntary admission to inpatient mental health treatment for . . . . . . days (not to exceed 14 days)
(Sign one):
. . . . . . If deemed appropriate by my agent (if appointed) and treating physician or advanced registered nurse practitioner
      . . . . . . . . . . . .
     (Signature)
or
. . . . . . Under the following circumstances (specify symptoms, behaviors, or circumstances that indicate the need for hospitalization) . . . . . . . . . . . .
      . . . . . . . . . . . .
     (Signature)
. . . . . . I do not consent, or authorize my agent (if appointed) to consent, to inpatient treatment
      . . . . . . . . . . . .
     (Signature)
Hospital Preferences and Instructions
If hospitalization is required, I prefer the following hospitals: . . . . . . . . . . . .
I do not consent to be admitted to the following hospitals: . . . . . . . . . . . .
E. Preferences and Instructions About Preemergency
I would like the interventions below to be tried before use of seclusion or restraint is considered
(initial all that apply):
. . . . . . "Talk me down" one-on-one
. . . . . . More medication
. . . . . . Time out/privacy
. . . . . . Show of authority/force
. . . . . . Shift my attention to something else
. . . . . . Set firm limits on my behavior
. . . . . . Help me to discuss/vent feelings
. . . . . . Decrease stimulation
. . . . . . Offer to have neutral person settle dispute
. . . . . . Other, specify . . . . . . . . . . . .
F. Preferences and Instructions About Seclusion, Restraint, and Emergency Medications
If it is determined that I am engaging in behavior that requires seclusion, physical restraint, and/or emergency use of medication, I prefer these interventions in the order I have chosen (choose "1" for first choice, "2" for second choice, and so on):
. . . . . . Seclusion
. . . . . . Seclusion and physical restraint (combined)
. . . . . . Medication by injection
. . . . . . Medication in pill or liquid form
In the event that my attending physician or advanced registered nurse practitioner decides to use medication in response to an emergency situation after due consideration of my preferences and instructions for emergency treatments stated above, I expect the choice of medication to reflect any preferences and instructions I have expressed in Part III C of this form. The preferences and instructions I express in this section regarding medication in emergency situations do not constitute consent to use of the medication for nonemergency treatment.
G. Preferences and Instructions About Electroconvulsive Therapy
(ECT or Shock Therapy)
My wishes regarding electroconvulsive therapy are (sign one):
. . . . . . I do not consent, nor authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy
      . . . . . . . . . . . .
     (Signature)
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy
      . . . . . . . . . . . .
     (Signature)
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy, but only under the following conditions: . . . . . . . . . . . .
. . . . . . . . . . . .
      . . . . . . . . . . . .
     (Signature)
H. Preferences and Instructions About Who is Permitted to Visit
If I have been admitted to a mental health treatment facility, the following people are not permitted to visit me there:
Name: . . . . . . . . . . . .
Name: . . . . . . . . . . . .
Name: . . . . . . . . . . . .
I understand that persons not listed above may be permitted to visit me.
I. Additional Instructions About My Mental Health Care
Other instructions about my mental health care: . . . . . . . . . . . .
. . . . . . . . . . . .
In case of emergency, please contact:
Name: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Work telephone: . . . . . . . . . . . . Home telephone: . . . . . . . . . . . .
Physician or Advanced Registered Nurse Practitioner: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Telephone: . . . . . . . . . . . .
The following may help me to avoid a hospitalization: . . . . . . . . . . . .
. . . . . . . . . . . .
I generally react to being hospitalized as follows: . . . . . . . . . . . .
. . . . . . . . . . . .
Staff of the hospital or crisis unit can help me by doing the following: . . . . . . . . . . . .
. . . . . . . . . . . .
. . . . . . . . . . . .
J. Refusal of Treatment
I do not consent to any mental health treatment.
      . . . . . . . . . . . .
     (Signature)

PART VI.
DURABLE POWER OF ATTORNEY (APPOINTMENT OF MY AGENT)
(Fill out this part only if you wish to appoint an agent or nominate a guardian.)
     I authorize an agent to make mental health treatment decisions on my behalf. The authority granted to my agent includes the right to consent, refuse consent, or withdraw consent to any mental health care, treatment, service, or procedure, consistent with any instructions and/or limitations I have set forth in this directive. I intend that those decisions should be made in accordance with my expressed wishes as set forth in this document. If I have not expressed a choice in this document and my agent does not otherwise know my wishes, I authorize my agent to make the decision that my agent determines is in my best interest. This agency shall not be affected by my incapacity. Unless I state otherwise in this durable power of attorney, I may revoke it unless prohibited by other state law.
A. Designation of an Agent
     I appoint the following person as my agent to make mental health treatment decisions for me as authorized in this document and request that this person be notified immediately when this directive becomes effective:
Name: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Work telephone: . . . . . . . . . . . . Home telephone: . . . . . . . . . . . .
Relationship: . . . . . . . . . . . .
B. Designation of Alternate Agent
If the person named above is unavailable, unable, or refuses to serve as my agent, or I revoke that person's authority to serve as my agent, I hereby appoint the following person as my alternate agent and request that this person be notified immediately when this directive becomes effective or when my original agent is no longer my agent:
Name: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Work telephone: . . . . . . . . . . . . Home telephone: . . . . . . . . . . . .
Relationship: . . . . . . . . . . . .
C. When My Spouse is My Agent (initial if desired)
. . . . . . If my spouse is my agent, that person shall remain my agent even if we become legally separated or our marriage is dissolved, unless there is a court order to the contrary or I have remarried.
D. Limitations on My Agent's Authority
I do not grant my agent the authority to consent on my behalf to the following:
. . . . . . . . . . . .
. . . . . . . . . . . .
E. Limitations on My Ability to Revoke this Durable Power of Attorney
I choose to limit my ability to revoke this durable power of attorney as follows:
. . . . . . . . . . . .
. . . . . . . . . . . .
F. Preference as to Court-Appointed Guardian
In the event a court appoints a guardian who will make decisions regarding my mental health treatment, I nominate the following person as my guardian:
Name: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Work telephone: . . . . . . . . . . . . Home telephone: . . . . . . . . . . . .
Relationship: . . . . . . . . . . . .
The appointment of a guardian of my estate or my person or any other decision maker shall not give the guardian or decision maker the power to revoke, suspend, or terminate this directive or the powers of my agent, except as authorized by law.
      . . . . . . . . . . . .
(Signature required if nomination is made)

PART VII.
OTHER DOCUMENTS
(Initial all that apply)
I have executed the following documents that include the power to make decisions regarding health care services for myself:
. . . . . . Health care power of attorney (chapter 11.94 RCW)
. . . . . . "Living will" (Health care directive; chapter 70.122 RCW)
. . . . . . I have appointed more than one agent. I understand that the most recently appointed agent controls except as stated below:
. . . . . . . . . . . .

PART VIII.
NOTIFICATION OF OTHERS AND CARE OF PERSONAL AFFAIRS
(Fill out this part only if you wish to provide nontreatment instructions.)
I understand the preferences and instructions in this part are NOT the responsibility of my treatment provider and that no treatment provider is required to act on them.
A. Who Should Be Notified
I desire my agent to notify the following individuals as soon as possible when this directive becomes effective:
Name: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Day telephone: . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . .
Name: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Day telephone: . . . . . . . . . . . . Evening telephone: . . . . . . . . . . . .
B. Preferences or Instructions About Personal Affairs
I have the following preferences or instructions about my personal affairs (e.g., care of dependents, pets, household) if I am admitted to a mental health treatment facility:
. . . . . . . . . . . .
. . . . . . . . . . . .
C. Additional Preferences and Instructions:
. . . . . . . . . . . .
. . . . . . . . . . . .
. . . . . . . . . . . .
. . . . . . . . . . . .

PART IX.
SIGNATURE
     By signing here, I indicate that I understand the purpose and effect of this document and that I am giving my informed consent to the treatments and/or admission to which I have consented or authorized my agent to consent in this directive. I intend that my consent in this directive be construed as being consistent with the elements of informed consent under chapter 7.70 RCW.
     Signature: . . . . . . . . . . . . Date: . . . . . . . . . . . .
     Printed Name: . . . . . . . . . . . .
This directive was signed and declared by the "Principal," to be his or her directive, in our presence who, at his or her request, have signed our names below as witnesses. We declare that, at the time of the creation of this instrument, the Principal is personally known to us, and, according to our best knowledge and belief, has capacity at this time and does not appear to be acting under duress, undue influence, or fraud. We further declare that none of us is:
     (A) A person designated to make medical decisions on the principal's behalf;
     (B) A health care provider or professional person directly involved with the provision of care to the principal at the time the directive is executed;
     (C) An owner, operator, employee, or relative of an owner or operator of a health care facility or long-term care facility in which the principal is a patient or resident;
     (D) A person who is related by blood, marriage, or adoption to the person, or with whom the principal has a dating relationship as defined in RCW 26.50.010;
     (E) An incapacitated person;
     (F) A person who would benefit financially if the principal undergoes mental health treatment; or
     (G) A minor.
Witness 1: Signature: . . . . . . . . . . . . Date: . . . . . . . . . . . .
     Printed Name: . . . . . . . . . . . .
          Telephone: . . . . . . . . . . . . Address: . . . . . . . . . . . .
Witness 2: Signature: . . . . . . . . . . . . Date: . . . . . . . . . . . .
     Printed Name: . . . . . . . . . . . .
          Telephone: . . . . . . . . . . . . Address: . . . . . . . . . . . .

PART X.
RECORD OF DIRECTIVE
I have given a copy of this directive to the following persons: . . . . . . . . . . . .
. . . . . . . . . . . .
DO NOT FILL OUT PART XI UNLESS YOU INTEND TO REVOKE
THIS DIRECTIVE IN PART OR IN WHOLE

PART XI.
REVOCATION OF THIS DIRECTIVE
(Initial any that apply):
. . . . . . I am revoking the following part(s) of this directive (specify): . . . . . . . . . . . .
. . . . . . . . . . . .
. . . . . . I am revoking all of this directive.
By signing here, I indicate that I understand the purpose and effect of my revocation and that no person is bound by any revoked provision(s). I intend this revocation to be interpreted as if I had never completed the revoked provision(s).
     Signature: . . . . . . . . . . . . Date: . . . . . . . . . . . .
     Printed Name: . . . . . . . . . . . .
DO NOT SIGN THIS PART UNLESS YOU INTEND TO REVOKE THIS
DIRECTIVE IN PART OR IN WHOLE

Sec. 15   RCW 71.34.355 and 1985 c 354 s 16 are each amended to read as follows:
     Absent a risk to self or others, minors treated under this chapter have the following rights, which shall be prominently posted in the evaluation and treatment facility:
     (1) To wear their own clothes and to keep and use personal possessions;
     (2) To keep and be allowed to spend a reasonable sum of their own money for canteen expenses and small purchases;
     (3) To have individual storage space for private use;
     (4) To have visitors at reasonable times;
     (5) To have reasonable access to a telephone, both to make and receive confidential calls;
     (6) To have ready access to letter-writing materials, including stamps, and to send and receive uncensored correspondence through the mails;
     (7) To discuss treatment plans and decisions with mental health professionals;
     (8) To have the right to adequate care and individualized treatment;
     (9) Not to consent to the performance of electro-convulsive treatment or surgery, except emergency life-saving surgery, upon him or her, and not to have electro-convulsive treatment or nonemergency surgery in such circumstance unless ordered by a court pursuant to a judicial hearing in which the minor is present and represented by counsel, and the court shall appoint a psychiatrist, psychologist, advanced registered nurse practitioner, or physician designated by the minor or the minor's counsel to testify on behalf of the minor. The minor's parent may exercise this right on the minor's behalf, and must be informed of any impending treatment;
     (10) Not to have psychosurgery performed on him or her under any circumstances.

Sec. 16   RCW 71.34.720 and 1991 c 364 s 12 are each amended to read as follows:
     (1) Each minor approved by the facility for inpatient admission shall be examined and evaluated by a children's mental health specialist as to the child's mental condition and by a physician or advanced registered nurse practitioner as to the child's physical condition within twenty-four hours of admission. Reasonable measures shall be taken to ensure medical treatment is provided for any condition requiring immediate medical attention.
     (2) If, after examination and evaluation, the children's mental health specialist and the physician or advanced registered nurse practitioner determine that the initial needs of the minor would be better served by placement in a chemical dependency treatment facility, then the minor shall be referred to an approved treatment program defined under RCW 70.96A.020.
     (3) The admitting facility shall take reasonable steps to notify immediately the minor's parent of the admission.
     (4) During the initial seventy-two hour treatment period, the minor has a right to associate or receive communications from parents or others unless the professional person in charge determines that such communication would be seriously detrimental to the minor's condition or treatment and so indicates in the minor's clinical record, and notifies the minor's parents of this determination. In no event may the minor be denied the opportunity to consult an attorney.
     (5) If the evaluation and treatment facility admits the minor, it may detain the minor for evaluation and treatment for a period not to exceed seventy-two hours from the time of provisional acceptance. The computation of such seventy-two hour period shall exclude Saturdays, Sundays, and holidays. This initial treatment period shall not exceed seventy-two hours except when an application for voluntary inpatient treatment is received or a petition for fourteen-day commitment is filed.
     (6) Within twelve hours of the admission, the facility shall advise the minor of his or her rights as set forth in this chapter.

Sec. 17   RCW 71.34.730 and 1995 c 312 s 54 are each amended to read as follows:
     (1) The professional person in charge of an evaluation and treatment facility where a minor has been admitted involuntarily for the initial seventy-two hour treatment period under this chapter may petition to have a minor committed to an evaluation and treatment facility for fourteen-day diagnosis, evaluation, and treatment.
     If the professional person in charge of the treatment and evaluation facility does not petition to have the minor committed, the parent who has custody of the minor may seek review of that decision in court. The parent shall file notice with the court and provide a copy of the treatment and evaluation facility's report.
     (2) A petition for commitment of a minor under this section shall be filed with the superior court in the county where the minor is residing or being detained.
     (a) A petition for a fourteen-day commitment shall be signed ((either)) (i) by two physicians or two advanced registered nurse practitioners or (ii) by ((one physician and)) a mental health professional ((who)) and either a physician or an advanced registered nurse practitioner. The person signing the petition must have examined the minor, and ((shall)) the petition must contain the following:
     (((i))) (A) The name and address of the petitioner;
     (((ii))) (B) The name of the minor alleged to meet the criteria for fourteen-day commitment;
     (((iii))) (C) The name, telephone number, and address if known of every person believed by the petitioner to be legally responsible for the minor;
     (((iv))) (D) A statement that the petitioner has examined the minor and finds that the minor's condition meets required criteria for fourteen-day commitment and the supporting facts therefor;
     (((v))) (E) A statement that the minor has been advised of the need for voluntary treatment but has been unwilling or unable to consent to necessary treatment;
     (((vi))) (F) A statement recommending the appropriate facility or facilities to provide the necessary treatment; and
     (((vii))) (G) A statement concerning whether a less restrictive alternative to inpatient treatment is in the best interests of the minor.
     (b) A copy of the petition shall be personally delivered to the minor by the petitioner or petitioner's designee. A copy of the petition shall be sent to the minor's attorney and the minor's parent.

Sec. 18   RCW 71.34.750 and 1985 c 354 s 9 are each amended to read as follows:
     (1) At any time during the minor's period of fourteen-day commitment, the professional person in charge may petition the court for an order requiring the minor to undergo an additional one hundred eighty-day period of treatment. The evidence in support of the petition shall be presented by the county prosecutor unless the petition is filed by the professional person in charge of a state-operated facility in which case the evidence shall be presented by the attorney general.
     (2) The petition for one hundred eighty-day commitment shall contain the following:
     (a) The name and address of the petitioner or petitioners;
     (b) The name of the minor alleged to meet the criteria for one hundred eighty-day commitment;
     (c) A statement that the petitioner is the professional person in charge of the evaluation and treatment facility responsible for the treatment of the minor;
     (d) The date of the fourteen-day commitment order; and
     (e) A summary of the facts supporting the petition.
     (3) The petition shall be supported by accompanying affidavits signed by (a) two examining physicians, one of whom shall be a child psychiatrist, or two advanced registered nurse practitioners, one of whom shall be a psychiatric advanced registered nurse practitioner, or by ((one examining physician and)) (b) one children's mental health specialist and either an examining physician or an advanced registered nurse practitioner. The affidavits shall describe in detail the behavior of the detained minor which supports the petition and shall state whether a less restrictive alternative to inpatient treatment is in the best interests of the minor.
     (4) The petition for one hundred eighty-day commitment shall be filed with the clerk of the court at least three days before the expiration of the fourteen-day commitment period. The petitioner or the petitioner's designee shall within twenty-four hours of filing serve a copy of the petition on the minor and notify the minor's attorney and the minor's parent. A copy of the petition shall be provided to such persons at least twenty-four hours prior to the hearing.
     (5) At the time of filing, the court shall set a date within seven days for the hearing on the petition. The court may continue the hearing upon the written request of the minor or the minor's attorney for not more than ten days. The minor or the parents shall be afforded the same rights as in a fourteen-day commitment hearing. Treatment of the minor shall continue pending the proceeding.
     (6) For one hundred eighty-day commitment, the court must find by clear, cogent, and convincing evidence that the minor:
     (a) Is suffering from a mental disorder;
     (b) Presents a likelihood of serious harm or is gravely disabled; and
     (c) Is in need of further treatment that only can be provided in a one hundred eighty-day commitment.
     (7) If the court finds that the criteria for commitment are met and that less restrictive treatment in a community setting is not appropriate or available, the court shall order the minor committed for further inpatient treatment to the custody of the secretary or to a private treatment and evaluation facility if the minor's parents have assumed responsibility for payment for the treatment. If the court finds that a less restrictive alternative is in the best interest of the minor, the court shall order less restrictive alternative treatment upon such conditions as necessary.
     If the court determines that the minor does not meet the criteria for one hundred eighty-day commitment, the minor shall be released.
     (8) Successive one hundred eighty-day commitments are permissible on the same grounds and under the same procedures as the original one hundred eighty-day commitment. Such petitions shall be filed at least five days prior to the expiration of the previous one hundred eighty-day commitment order.

Sec. 19   RCW 71.34.770 and 1985 c 354 s 12 are each amended to read as follows:
     (1) The professional person in charge of the inpatient treatment facility may authorize release for the minor under such conditions as appropriate. Conditional release may be revoked pursuant to RCW 71.34.780 if leave conditions are not met or the minor's functioning substantially deteriorates.
     (2) Minors may be discharged prior to expiration of the commitment period if the treating physician, advanced registered nurse practitioner, or professional person in charge concludes that the minor no longer meets commitment criteria.

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