Medical Hold

Medical Hold – Chelsea Sprick, Barrington Hwang


  • 6404: applies when there is a need for psychiatric hospitalization
    • Can only be completed by a licensed physician
      • Psychiatry residents can write these due to their special training licenses
  • No AMA Medical Hold: useful when a pt does not have capacity to leave the hospital against medical advice and needs to remain in the hospital
    • Can be ordered by any physician
  • 6401 vs. 6404: Tennessee Title 33, Chapter 6, Part 4 is the legal code
    • "6401": the form needed for emergency detention, examination and admissio
      • One person completes this
  • "6404": the certificates for emergency involuntary admission
    • The first 6404 is needed to transport a patient to a psychiatric facility and the second 6404 is needed for an involuntary admission
    • Pt must have mental illness or serious emotional disturbance, excluding intellectual/developmental disabilities and pose an immediate substantial likelihood of serious harm because of this, as evidenced by current/past SI/HI/SIB or deterioration at point of inability to care for self at significant risk to self or others
    • Treatment must be necessary for symptom reduction and lack of treatment would lead to deterioration, with no less drastic alternative to inpatient hospitalization.
    • Two different qualified persons must each complete a form


Additional Information

  • VUH-specific procedures
    • A physical copy of (at least) the first 6404 is required to accompany the patient when they are transported to a psychiatric facility after medical discharge
    • Once completed, 6404s should be given to the medical receptionist on the unit for scanning into the medical record and for safe-keeping
  • Consider whether a pt has a conservator or activated healthcare POA
  • If the conservator/POA is willing and able to complete the consent for admission, the pt can be admitted voluntarily
    • The first 6404 would still be necessary for transportation to a psychiatric facility
  • Unless the pt has a mental health-related condition or qualifies under the criteria above, pt is NOT committable under the involuntary admission 
  • Just because someone wants to leave to use substances does not in itself mean they are committable, even if it does not seem like a good decision
  • While this may seem obvious, a 6404 or No AMA/Medical Hold takes away the personal liberties of an individual and this is a serious decision