The application described in Section 5-305 of this title shall be accompanied by a certificate in duplicate signed by a licensed doctor of medicine or osteopathic physician who is duly licensed to practice his such profession by the Oklahoma State Board of Medical Licensure and Supervision or the Oklahoma Board of Osteopathic Examiners, who is not related by blood or marriage to the person being examined, and who has no interest in the estate of the person being examined. This certificate shall include the following:

1. A statement that a physician licensed in this state has personally examined the person;

2. A statement that such physician is not related by blood or marriage to the person being examined and has no interest in the estate of the person being examined;

3. A determination that the person has a mental illness that requires inpatient admission;

4. A statement that the person may not be held at the facility for longer than one hundred twenty (120) hours or five (5) days, excluding weekends and holidays, past the time when such person has revoked consent to stay for treatment;

5. Information on the benefits and side effects of the treatment the person will receive in an inpatient setting;

6. Certification that the person has made a knowing and willing consent to voluntary inpatient treatment; and

7. The physician’s signature made under penalty of perjury.

Added by Laws 1963, c. 81, § 3, emerg. eff. May 21, 1963. Renumbered from Title 43A, § 553 by Laws 1986, c. 103, § 103, eff. Nov. 1, 1986. Amended by Laws 1987, c. 118, § 3, operative July 1, 1987; Laws 2003, c. 46, § 38, emerg. eff. April 8, 2003; Laws 2005, c. 150, § 43, emerg. eff. May 9, 2005; Laws 2008, c. 401, § 15, eff. Nov. 1, 2008; Laws 2010, c. 287, § 28, eff. Nov. 1, 2010.