CON Writer
©2019
Ben Smith, MD, FACEP
about
About
This is a fully HIPPA compliant in-broswer PDF generator.
This tool generates a TN Certificate of Need for involuntary psychiatric commitment.
No patient specific information typed in here is sent to the web.
Destination, Transport method, and County will be logged.
This use of this tool does not constitiute any form of medical advice.
Provider Phone, County, Transport Method, and Destination will be stored in your browser for the next time you visit this page.
Patient Name
Provider Name
Provider Phone
County
Anderson
Bedford
Benton
Bledsoe
Blount
Bradley
Campbell
Cannon
Carroll
Carter
Cheatham
Chester
Claiborne
Clay
Cocke
Coffee
Crockett
Cumberland
Davidson
Decatur
DeKalb
Dickson
Dyer
Fayette
Fentress
Franklin
Gibson
Giles
Grainger
Greene
Grundy
Hamblen
Hamilton
Hancock
Hardeman
Hardin
Hawkins
Haywood
Henderson
Henry
Hickman
Houston
Humphreys
Jackson
Jefferson
Johnson
Knox
Lake
Lauderdale
Lawrence
Lewis
Lincoln
Loudon
Macon
Madison
Marion
Marshall
Maury
McMinn
McNairy
Meigs
Monroe
Montgomery
Moore
Morgan
Obion
Overton
Perry
Pickett
Polk
Putnam
Rhea
Roane
Robertson
Rutherford
Scott
Sequatchie
Sevier
Shelby
Smith
Stewart
Sullivan
Sumner
Tipton
Trousdale
Unicoi
Union
Van Buren
Warren
Washington
Wayne
Weakley
White
Williamson
Wilson
Transport Method
Friends/Family
Ambulance
Sheriff/Law Enforcement
Destination
Psychiatric Facility
Telehealth Location
Create
1) Has a mental illness or serious emotional disturbance...
Has a history of depression, now with suicidal ideation and a plan.
Has a history of bipolar disorder, now presents with acute mania.
Has a history of schizophrenia, now has symptoms of acute psychosis.
2) Poses a high likelihood of harm...
Has serious thoughts of suicide with a clear plan.
Has threatened homicide and serious injury to others.
Disorganized thoughts put the patient and others at substantial risk of harm.
3) Describe what makes treatment necessary...
Needs intensive inpatient psychiatric care.
Lack of inpatient care will likely result in harm to others.
Lack of inpatient care will likely result in harm to the patient.
4) List alt Tx considered and rational for rejection...
Not appropriate for outpatient management.
The patient cannot contract for safety.