Understanding the Pink Slip laws in Ohio

Pink Slip law in Ohio

1. Presented by
Marc 
Baumgarten 
& 
Denise Cole 
ODMH
UNDERSTANDING THE 
USE OF “PINK SLIPS” 
FOR BEHAVIORAL 
HEALTH PATIENTS

2. P
What is a “pink slip”? What is a “pink slip”? What is a “pink slip”? What is a “pink slip”?
P
Euphemism used to identify document  Euphemism used to identify document  Euphemism used to identify document  Euphemism used to identify document 
referenced in Revised Code Section 5122.10 referenced in Revised Code Section 5122.10 referenced in Revised Code Section 5122.10 referenced in Revised Code Section 5122.10
P
Document Document Document Document utilized utilized utilized utilized tototo to obtain obtain obtain obtain emergency emergency emergency emergency
hospitalization hospitalization hospitalization hospitalization forforfor for ananan an individual individual individual individual whowhowhowho isisis is 1111))))
mentally mentally mentally mentally illillill ill subject subject subject subject tototo to hospitalization hospitalization hospitalization hospitalization bybyby by court court court court
order, order, order, order, andandandand 2222)))) represents represents represents represents aaaa substantial substantial substantial substantial risk riskrisk risk ofofof of
physical physical physical physical harmharmharm harm tototo to him/herself him/herself him/herself him/herself ororor or others others others others ififif if
allowed allowed allowed allowed tototo to remain remain remain remain atatat at liberty liberty liberty liberty pending pending pending pending
examination examination examination examination
DEFINITION OF “PINK SLIP”

3. “Pink slip” is the common
termforthepaperworkused
todetainanindividualforthe
purpose of emergency
hospitalization. Technically,
the correct term is
“Application for Emergency
Admission.”

6. P
5122 51225122 5122....101010 10 Emergency Emergency Emergency Emergency hospitalization hospitalization hospitalization hospitalization
P
AnyAnyAnyAny psychiatrist, psychiatrist, psychiatrist, psychiatrist, licensed licensed licensed licensed clinical clinical clinical clinical psychologist, psychologist, psychologist, psychologist, licensed licensed licensed licensed
physician, physician, physician, physician, health health health health officer, officer, officer, officer, parole parole parole parole officer, officer, officer, officer, police police police police officer, officer, officer, officer, ororor or sheriff sheriff sheriff sheriff
maymaymaymay taketaketake take aaaa person person person person intointointo into custody, custody, custody, custody, ororor or thethethethe chief chief chief chief ofofof of thethethethe adult adult adult adult parole parole parole parole
authority authority authority authority ororor or aaaa parole parole parole parole ororor or probation probation probation probation officer officer officer officer withwithwith with thethethethe approval approval approval approval ofofof of
thethethethe chief chief chief chief ofofof of thethethethe authority authority authority authority maymaymaymay taketaketake take aaaa parolee, parolee, parolee, parolee, ananan an offender offender offender offender underunder under under
aaaa community community community community controlcontrol control control sanction sanction sanction sanction ororor or aaaa postpostpost post----release release release release control control control control
sanction, sanction, sanction, sanction, ororor or ananan an offender offender offender offender underunder under under transitional transitional transitional transitional control control control control intointointo into custody custody custody custody
andandandand maymaymaymay immediately immediately immediately immediately transport transport transport transport thethethethe parolee, parolee, parolee, parolee, offender offender offender offender ononon on
community community community community controlcontrol control control ororor or postpostpost post----release release release release control, control, control, control, ororor or offender offender offender offender underunder under under
transitional transitional transitional transitional control control control control tototo to aaaa hospital hospital hospital hospital or,or,or,or, notwithstanding notwithstanding notwithstanding notwithstanding section section section section
5119 51195119 5119....202020 20
ofofof of thethethethe Revised Revised Revised Revised Code,Code, Code, Code, tototo to aaaa general general general general hospital hospital hospital hospital notnotnotnot licensed licensed licensed licensed
bybyby by thethethethe department department department department ofofof of mental mental mental mental health health health health where where where where thethethethe parolee, parolee, parolee, parolee, offender offender offender offender
ononon on community community community community control control control control ororor or postpostpost post----release release release release control, control, control, control, ororor or offender offender offender offender underunder under under
transitional transitional transitional transitional control control control control maymaymaymay bebebe be heldheldheld held forforforfor thethethethe period period period period prescribed prescribed prescribed prescribed ininin in
this thisthis this section, section, section, section, ififif if thethethethe psychiatrist, psychiatrist, psychiatrist, psychiatrist, licensed licensed licensed licensed clinical clinical clinical clinical psychologist, psychologist, psychologist, psychologist,
licensed licensed licensed licensed physician, physician, physician, physician, health health health health officer, officer, officer, officer, parole parole parole parole officer, officer, officer, officer, police police police police officer, officer, officer, officer,
ororor or sheriff sheriff sheriff sheriff hashashashas reason reason reason reason tototo to believe believe believe believe thatthatthat that thethethethe person person person person isisis is aaaa mentally mentally mentally mentally illillill ill
person person person person subject subject subject subject tototo to hospitalization hospitalization hospitalization hospitalization bybyby by court court court court order order order order under under under under division division division division
(B)(B)(B)(B) ofofof of section section section section
5122 51225122 5122....010101 01
ofofof of thethethethe Revised Revised Revised Revised Code,Code, Code, Code, andandandand represents represents represents represents aaaa
substantial substantial substantial substantial riskriskrisk risk ofofof of physical physical physical physical harmharmharm harm tototo to selfselfself self ororor or others others others others ififif if allowed allowed allowed allowed tototo to
remain remain remain remain atatat at liberty liberty liberty liberty pending pending pending pending examination examination examination examination....
P
AAAA written written written written statement statement statement statement shallshall shall shall bebebe be givengiven given given tototo to suchsuchsuch such hospital hospital hospital hospital bybyby by thethethethe
transporting transporting transporting transporting psychiatrist, psychiatrist, psychiatrist, psychiatrist, licensed licensed licensed licensed clinical clinical clinical clinical psychologist, psychologist, psychologist, psychologist,
licensed licensed licensed licensed physician, physician, physician, physician, health health health health officer, officer, officer, officer, parole parole parole parole officer, officer, officer, officer, police police police police officer, officer, officer, officer,
chief chief chief chief ofofof of thethethethe adult adult adult adult parole parole parole parole authority, authority, authority, authority, parole parole parole parole ororor or probation probation probation probation officer, officer, officer, officer,
ororor or sheriff sheriff sheriff sheriff stating stating stating stating thethethethe circumstances circumstances circumstances circumstances underunder under under whichwhich which which suchsuchsuch such person person person person
waswaswaswas takentaken taken taken intointointo into custody custody custody custody andandandand thethethethe reasons reasons reasons reasons forforforfor thethethethe psychiatrist’s, psychiatrist’s, psychiatrist’s, psychiatrist’s,
licensed licensed licensed licensed clinical clinical clinical clinical psychologist’s, psychologist’s, psychologist’s, psychologist’s, licensed licensed licensed licensed physician’s, physician’s, physician’s, physician’s, health health health health
officer’s, officer’s, officer’s, officer’s, parole parole parole parole officer’s, officer’s, officer’s, officer’s, police police police police officer’s, officer’s, officer’s, officer’s, chief chief chief chief ofofof of thethethethe adult adult adult adult
parole parole parole parole authority’s, authority’s, authority’s, authority’s, parole parole parole parole ororor or probation probation probation probation officer’s, officer’s, officer’s, officer’s, ororor or sheriff’s sheriff’s sheriff’s sheriff’s
belief belief belief belief.... ThisThisThis This statement statement statement statement shallshall shall shall bebebe be mademademade made available available available available tototo to thethethethe
respondent respondent respondent respondent ororor or thethethethe respondent’s respondent’s respondent’s respondent’s attorney attorney attorney attorney uponuponupon upon request request request request ofofof of either either either either....
P
Every Every Every Every reasonable reasonable reasonable reasonable andandandand appropriate appropriate appropriate appropriate effort effort effort effort shall shall shall shall bebebe be mademademade made tototo to taketaketake take
persons persons persons persons intointointo into custody custody custody custody ininin in thethethethe least least least least conspicuous conspicuous conspicuous conspicuous mannermanner manner manner possible possible possible possible....
AAAA person person person person taking taking taking taking thethethethe respondent respondent respondent respondent intointointo into custody custody custody custody pursuant pursuant pursuant pursuant tototo to thisthisthis this
section section section section shall shall shall shall explain explain explain explain tototo to thethethethe respondent respondent respondent respondent:::: thethethethe name, name, name, name, professional professional professional professional
designation, designation, designation, designation, andandandand agency agency agency agency affiliation affiliation affiliation affiliation ofofof of thethethethe person person person person taking taking taking taking thethethethe
respondent respondent respondent respondent intointointo into custody custody custody custody;;;; thatthatthat that thethethethe custody custody custody custody ----taking taking taking taking isisis is notnotnotnot aaaa
criminal criminal criminal criminal arrestarrest arrest arrest;;;; andandandand thatthatthat that thethethethe person person person person isisis is being being being being takentaken taken taken forforforfor
examination examination examination examination bybyby by mental mental mental mental healthhealth health health professionals professionals professionals professionals atatat at aaaa specified specified specified specified
mental mental mental mental health health health health facility facility facility facility identified identified identified identified bybyby by namenamename name....
○ First 
paragraph 
defines who 
can pink slip 
and 
requirements
○ Second 
paragraph 
identifies 
“statement of 
belief” listed 
on pink slip
○ Third 
paragraph 
identifies 
important 
patient rights 
issues when 
taking patient 
into custody
OHIO 
REVISED 
CODE 
RELATED 
TO PINK 
SLIP 

7. P
Ohio OhioOhio Ohio Revised Revised Revised Revised CodeCodeCode Code 512251225122 5122....10101010 (Continued) (Continued) (Continued) (Continued)
P
IfIfIf If aaaa person person person person takentaken taken taken intointointo into custody custody custody custody underunder under under thisthisthis this section section section section isisis is
transported transported transported transported tototo to aaaa general general general general hospital, hospital, hospital, hospital, thethethethe general general general general hospital hospital hospital hospital
maymaymaymay admitadmit admit admit thethethethe person, person, person, person, orororor provide provide provide provide carecarecare care andandandand treatment treatment treatment treatment
forforforfor thethethethe person, person, person, person, ororor or both,both, both, both, notwithstanding notwithstanding notwithstanding notwithstanding section section section section
5119 51195119 5119....202020 20
ofofof of thethethethe Revised Revised Revised Revised Code, Code, Code, Code, butbutbutbut bybyby by thethethethe endendendend ofofofof twenty twenty twenty twenty----
four fourfour four hours hours hours hours afterafter after after arrival arrival arrival arrival atatat at thethethethe general general general general hospital, hospital, hospital, hospital, thethethethe
person person person person shall shall shall shall bebebe be transferred transferred transferred transferred tototo to aaaa hospital hospital hospital hospital asasasas defined defined defined defined ininin in
section section section section
5122 51225122 5122....010101 01
ofofofof thethethethe Revised Revised Revised Revised CodeCodeCode Code....
P
AAAA person person person person transported transported transported transported ororor or transferred transferred transferred transferred tototo to aaaa hospital hospital hospital hospital ororor or
community community community community mentalmental mental mental health health health health agency agency agency agency underunder under under thisthisthis this section section section section
shall shall shall shall bebebe be examined examined examined examined bybyby by thethethethe staff staff staff staff ofofof of thethethethe hospital hospital hospital hospital ororor or agency agency agency agency
within within within within twenty twenty twenty twenty----four fourfour four hours hours hours hours after after after after arrival arrival arrival arrival atatat at thethethethe hospital hospital hospital hospital ororor or
agency agency agency agency.... IfIfIf If tototo to conduct conduct conduct conduct thethethethe examination examination examination examination requires requires requires requires thatthatthat that thethethethe
person person person person remain remain remain remain overnight, overnight, overnight, overnight, thethethethe hospital hospital hospital hospital ororor or agency agency agency agency shallshall shall shall
admit admit admit admit thethethethe person person person person ininin in ananan an unclassified unclassified unclassified unclassified status status status status until until until until making making making making
aaaa disposition disposition disposition disposition under under under under thisthisthis this section section section section.... After After After After thethethethe examination, examination, examination, examination,
ififif if thethethethe chief chief chief chief clinical clinical clinical clinical officer officer officer officer ofofof of thethethethe hospital hospital hospital hospital ororor or agency agency agency agency
believes believes believes believes thatthatthat that thethethethe person person person person isisis is notnotnotnot aaaa mentally mentally mentally mentally illillill ill person person person person
subject subject subject subject tototo to hospitalization hospitalization hospitalization hospitalization bybyby by court court court court order, order, order, order, thethethethe chief chief chief chief
clinical clinical clinical clinical officer officer officer officer shall shall shall shall release release release release ororor or discharge discharge discharge discharge thethethethe person person person person
immediately immediately immediately immediately unlessunless unless unless aaaa court court court court hashashashas issued issued issued issued aaaa temporary temporary temporary temporary
order order order order ofofof of detention detention detention detention applicable applicable applicable applicable tototo to thethethethe person person person person underunder under under
section section section section 512251225122 5122....111111 11 ofofof of thethethethe Revised Revised Revised Revised CodeCodeCode Code.... After After After After thethethethe
examination, examination, examination, examination, ififif if thethethethe chief chief chief chief clinical clinical clinical clinical officer officer officer officer believes believes believes believes thatthatthat that
thethethethe person person person person isisis is aaaa mentally mentally mentally mentally illillill ill person person person person subject subject subject subject tototo to
hospitalization hospitalization hospitalization hospitalization bybyby by court court court court order, order, order, order, thethethethe chief chief chief chief clinical clinical clinical clinical officer officer officer officer
maymaymaymay detain detain detain detain thethethethe person person person person forforforfor notnotnotnot moremoremore more thanthanthan than three three three three court court court court
days daysdays days following following following following thethethethe daydaydayday ofofof of thethethethe examination examination examination examination andandandand during during during during
such suchsuch such period period period period admit admit admit admit thethethethe person person person person asasas as aaaa voluntary voluntary voluntary voluntary patient patient patient patient
under under under under section section section section 512251225122 5122....020202 02 ofofof of thethethethe Revised Revised Revised Revised CodeCodeCode Code ororor or filefilefile file ananan an
affidavit affidavit affidavit affidavit under under under under section section section section 512251225122 5122....111111 11 ofofof of thethethethe Revised Revised Revised Revised CodeCodeCode Code.... IfIfIf If
neither neither neither neither action action action action isisis is taken taken taken taken andandandand aaaa court court court court hashashashas notnotnotnot otherwise otherwise otherwise otherwise
issued issued issued issued aaaa temporary temporary temporary temporary orderorder order order ofofof of detention detention detention detention applicable applicable applicable applicable tototo to thethethethe
person person person person under under under under section section section section 512251225122 5122....111111 11 ofofof of thethethethe Revised Revised Revised Revised Code, Code, Code, Code, thethethethe
chief chief chief chief clinical clinical clinical clinical officer officer officer officer shall shall shall shall discharge discharge discharge discharge thethethethe person person person person atatat at thethethethe
endendendend ofofof of thethethethe three three three three----daydaydayday period period period period unless unless unless unless thethethethe person person person person hashashashas beenbeenbeen been
sentenced sentenced sentenced sentenced tototo to thethethethe department department department department ofofof of rehabilitation rehabilitation rehabilitation rehabilitation andandandand
correction correction correction correction andandandand hashashashas notnotnotnot beenbeenbeen been released released released released fromfromfrom from thethethethe person’s person’s person’s person’s
sentence, sentence, sentence, sentence, ininin in which which which which casecasecase case thethethethe person person person person shall shall shall shall bebebe be returned returned returned returned tototo to
that thatthat that department department department department....
P
Effective Effective Effective Effective Date DateDate Date:::: 010101 01----010101 01----2004 20042004 2004
○ First 
paragraph 
identifies 
requirement  to 
transfer to 
hospital/unit 
licensed  or 
operated  by 
ODMH (within 24 
hours)
○ Second 
paragraph says 
that CCO has 24 
hours to 
examine patient 
& has 3 
subsequent 
court days to 
admit 
voluntarily  or to 
file affidavit for 
court ordered 
hospitalization
OHIO 
REVISED 
CODE 
RELATED 
TO PINK 
SLIP

8. P
To get individuals to safe environment 
where they can get treatment and 
recover
P
The “one use” paradigm
P
Common Sense Approach-If someone 
presents at hospital ED with licensed 
psychiatric unit, why send individual 
across town?
PURPOSE OF PINK SLIP

9. P
1) Have good policies and procedures
P
2) Follow those policies and procedures
P
3) Go to 1)
PINK SLIP TIPS

10. Related 
to Pink 
Slips
QUESTIONS FROM YOU 

11. P
Is a pink slip 
valid on a 
medical unit in 
a hospital with 
or without psych 
services 
present?
P
Since ORC 5122. 
addresses 
hospitalization of the 
mentally ill, a pink slip 
is appropriate if  
principal focus of 
treatment is mental 
illness, but not 
appropriate if principal 
focus of treatment is 
medical issue
PINK SLIP ON MEDICAL UNIT

12. P
Can facility 
name on 
original pink slip 
be altered to 
another facility 
and who 
can/should do 
this?
P
Pink slip is “one 
use” paradigm so 
cannot be used for a 
second facility
P
If a mistake has 
occurred, originator 
of pink slip may 
amend document 
according to medical 
record standards
FACILITY NAME CHANGE ON PINK SLIP

13. P
If original pink slip 
has expired, can 
new one be issued 
in order to move 
patient to 
psychiatric 
services?
P
Does pink slip 
expire after 72 
hours?
P
After pink slip 
expires, patient 
must be 
discharged, sign in 
voluntarily, or have 
court ordered 
hospitalization
P
Pink slip expires 
after 72 hours (3 
court days)
PINK SLIP EXPIRATION

14. P
How are hospitals 
dealing with issue 
of holding patient 
requiring 
admission who 
cannot be pink-
slipped and not 
having physician 
available to do it?
P
Cannot hold a 
patient against 
his/her will unless 
patient meets 
criteria for 
emergency 
hospitalization 
according to ORC 
5122.10
PATIENT HOLDS

15. P
Clarification of 24 
hour initial time 
frame and 
subsequent 72 
hours once 
patient is seen by 
psychiatrist and 
psychiatrist signs 
pink slip
P
CCO has 24 hours 
to examine 
patient & has 3 
court days to 
admit voluntarily 
or to file affidavit 
for court ordered 
hospitalization
TIME FRAMES

16. P
If patient placed on 
pink slip at 6 pm, for 
purposes of 3 court-
day time frame, 
when does pink slip 
start?
P
If CCO determines 
individual is mentally ill 
and subject to 
hospitalization by court 
order, CCO has 72 hours 
to either admit person 
voluntarily or file 
affidavit for court ordered 
hospitalization
P
Example: If pink-slipped 
on Friday night, would 
ignore Saturday & Sunday 
(not court days) and 72 
hours would end 6 pm 
following Wednesday
TIME FRAMES

17. P
Does pink slip 
expire when 
probate court 
closes or next AM 
when court 
opens?
P
Expiration of pink slip 
occurs according to 
time frame listed on 
pink slip, i.e. 72 hours 
from time that pink 
slip was initiated and 
“may detain the 
person for not more 
than three court days 
following the day of 
examination”
TIME FRAMES

18. P
Is it appropriate 
for receiving 
psychiatric facility 
to require 
voluntary patient 
to be pink slipped 
for transportation 
to their facility?
P
Patient cannot be 
pink-slipped 
unless patient 
meets criteria for 
emergency 
hospitalization 
according to ORC 
5122.10
PINK SLIP TO TRANSPORT

19. P
Does pink slip 
need facility name 
listed to be valid? 
If so, is it legal to 
pink slip again to 
another facility?
P
Pink slip is legal 
document that 
must be fully 
completed
P
Pink slip is “one 
use” paradigm
FACILITY NAME NECESSARY

20. P
If patient is 
probated to 
facility and needs 
transferred to 
another facility for 
ECT, does probate 
order need altered 
by court?
P
Hospital providing 
treatment for 
patient would 
need to be 
consistent with 
that of probate 
court order, so 
would need to 
amend with court
TRANSFER OF PROBATE PATIENT

21. P
Can psychiatric 
nurse practitioner 
sign pink slip?
P
Not defined in law
P
Check with 
Risk/Legal 
Department
P
Comply with Ohio 
Board of Nursing 
standards and 
hospital policies 
and procedures
NURSE PRACTITIONER FUNCTION

22. P
Can one pink 
slip minors? Is 
it illegal to 
transport 
minor to 
hospital on 
pink slip?
P
It is not 
prohibited by 
statute
MINORS AND PINK SLIPS

23. P
Is there such a 
thing as a medical 
hold (in-house 
physician pink-slips 
patient to medical 
floor to prevent 
him/her from 
leaving)?
P
Since ORC 5122. 
addresses 
hospitalization of the 
mentally ill, a pink 
slip is appropriate if  
principal focus of 
treatment is mental 
illness, but not 
appropriate if 
principal focus of 
treatment is medical 
issue
MEDICAL HOLD

24. P
Is the county court 
probate requirement 
correct that an 
individual must be 
transferred from the 
general hospital to 
psychiatry within 24 
hours of a pink slip?
P
By the end of 
twenty-four hours 
after arrival at the 
general hospital, the 
person shall be 
transferred to a 
hospital as defined 
in section 
5122.01
of the Revised Code.
PROBATE COURT REQUIREMENTS

25. P
Do all local law 
enforcement 
agencies (city 
police, sheriff’s 
dept.) have ability 
to initiate pink 
slip?
P
In accordance with ORC  In accordance with ORC  In accordance with ORC  In accordance with ORC 
5122.10, “A  5122.10, “A  5122.10, “A  5122.10, “A written  written  written  written 
statement shall be  statement shall be  statement shall be  statement shall be 
given to such hospital  given to such hospital  given to such hospital  given to such hospital 
by the transporting  by the transporting  by the transporting  by the transporting 
psychiatrist, licensed  psychiatrist, licensed  psychiatrist, licensed  psychiatrist, licensed 
clinical psychologist,  clinical psychologist,  clinical psychologist,  clinical psychologist, 
licensed physician,  licensed physician,  licensed physician,  licensed physician, 
health officer, parole  health officer, parole  health officer, parole  health officer, parole 
officer,  officer,  officer,  officer, police officer police officer police officer police officer, , ,  , 
chief of the adult  chief of the adult  chief of the adult  chief of the adult 
parole authority, parole  parole authority, parole  parole authority, parole  parole authority, parole 
or probation officer, or  or probation officer, or  or probation officer, or  or probation officer, or 
sheriff.” sheriff.” sheriff.” sheriff.”
INITIATING PINK SLIP

26. P
If patient is on 
medical-surgical unit 
and is found to be 
suicidal, can 
hospital’s police 
officers detain 
patient until 
psychiatrist has 
consulted and 
placed patient on 
pink slip?
P
Review on case by 
case basis
P
Consult with 
Risk/Legal 
Department
P
Follow hospital’s 
policies and 
procedures
P
Err on side of 
patient safety
HOSPITAL POLICE OFFICERS

27. P
Can another 
facility’s ED 
place patient on 
pink slip and 
send them to 
another 
hospital?
P
Pink slip is “one 
use” paradigm
P
Idea is to get 
person to safe 
location
ANOTHER FACILITY PINK SLIP

28. P
If person is placed 
on pink slip and 
needs transported 
to state hospital, 
does ORC specify 
local law 
enforcement must 
transport?
P
No, not defined in 
statute
TRANSPORT TO STATE HOSPITAL

29. Additional 
Questions?
CONTACT INFORMATION: 
DENISE COLE, PRIVATE PSYCHIATRIC 
PROGRAM ADMINISTRATOR
OFFICE OF LICENSURE AND 
CERTIFICATION
OHIO DEPT. OF MENTAL HEALTH
7
TH
FLOOR
30 E. BROAD STREET, COLUMBUS, OH
[phone]
MARC  BAUMGARTEN, CHIEF
OFFICE OF LEGAL SERVICES
OHIO DEPT.OF MENTAL HEALTH
8
TH
FLOOR
30 E. BROAD STREET
COLUMBUS, OH 43215
[phone]