For Receiving Facilities

Data Reporting Requirements

What to Submit

We receive involuntary examination forms from the 125+ Florida Department of Children & Families designated receiving facilities statewide. The Baker Act specifies that the following must be submitted to DCF within five working days. The receipt of these forms by the Baker Act Reporting Center is addressed in Florida Administrative Code (65E-5). [The statutory reference relevant to submission of each type of form is listed for each form.]

Report of Law Enforcement Officers Initiating Involuntary Examination (CF-MH 3052a) [394.463(2)(a)2]

Certificate of Professional Initiating Involuntary Examination (CF-MH 3052b) [394.463(2)(a)3]

Ex-parte Order for Involuntary Examination (CF-MH 3001) [394.463(2)(a)1]

Baker Act receiving facilities are required to include a Cover Sheet to the Department of Children and Families (CF-MH 3118) with the 3052a, 3052b and 3001 forms as specified in Florida Administrative Code [F.A.C. 65E-5.280(5)].

Forms 3052a, 3052b, and 3118 are mandatory forms that may not be changed.  The form for ex-parte orders for involuntary examination (3001) is a suggested form, such that jurisdictions are allowed to revise this form.  Many facilities pre-print the provider information on the Cover Sheet (3118), including the provider name, address, phone number and FMHI number. Contact the Baker Act Reporting Center if you would like assistance with information for the Cover Sheet, including the FMHI number. Each Baker Act receiving facility is assigned a unique FMHI number. This FMHI  number is important because some facilities have similar names, making it difficult for our data entry staff to quickly and accurately identify the correct provider.  

What NOT to Submit

Baker Act receiving facilities are not required to submit forms for involuntary inpatient placement, involuntary outpatient services (what was called involuntary outpatient placement prior to July 2016), or treatment plans for involuntary services. Forms other than those listed above, such as form CF-MH 3100 (Transportation to Receiving Facility), should NOT be submitted.  These documents are sorted from the mail and securely shredded.  

We do not receive forms for voluntary examination or for Marchman Act assessments.  

Other Data Reporting Requirements

This website focuses on required submission to the Baker Act Reporting Center.  However, there are other data reporting requirements in the Baker Act, including submission of the following:

  • Data submitted by publicly funded receiving facilities annual to DCF as specified in F.S. 394.461(4)(a)
  • Data submitted by publicly funded receiving facilities to the Managing Entity for the Acute Care Services Utilization Database as specified in F.S. 394.9082(10)
  • Copies submitted by the administrator of the treatment facility of involuntary services certificates and state mental health discharge forms to the Managing Entity that serves the county in which the person will reside as specified in F.S. 394.4655(3)(a)3(c)1

The Baker Act Reporting Center does not receive Marchman Act forms/data.  There are additional data reporting requirements in the Marchman Act such as submission of forms/data to the Managing Entity as specified in F.S. 397.697(4).

Please note that this is not an exhaustive list of all data reporting requirements in the Baker Act and Marchman Act.  Providers may contact the Managing Entity for the areas they serve for guidance on data submission requirements to the ME.