January 5150 Training (F) - Systems Training

Identifying information

Please complete all fields. Use the same First name and Last Name with the exact same spelling as on your license and/or past 5150 certification cards, unless your name has changed.

If you are only taking this for educational purposes and not seeking certification, please enter “XXX” for License/Registration type and number.

Please see the CCSF policy for information about who is eligible for 5150 authorization.

Licensed mental health professionals and related licensed professionals in designated facilities.
Licensed physicians in hospital emergency departments or approved settings.
Licensed mental health professionals in authorized facilitates or community health settings.
Board registered mental health professionals working under supervision.
Specially trained paramedics in specific programs.
Mental health professionals approved by the Director of Behavioral Health. This must be arranged by your program director in advance.

1. I understand that if I do not have one of the licenses listed above, I am either taking this training for educational purposes only or my program director has gained permission for me to be certified prior to this training. *This question is required.

January 5150 Training (F) - Systems Training - Part 1

Identifying information