RULE 6.2
PETITION FOR FOURTEEN-DAY INVOLUNTARY TREATMENT
The petition for 14-day involuntary treatment shall contain the following:
(a) The name and address of the petitioner(s).
(b) The name of the person alleged, as a result of mental disorder,
to present a likelihood of serious harm to him/herself, others, or the
property of others, or to be gravely disabled, and, if known to the
petitioner, the address, age, sex, marital status and occupation of the
person. Such person shall be denominated the respondent.
(c) The facts upon which the allegations of the petition are based.
(d) The name of every person known or believed by the petitioner to
be legally responsible for the care, support, and maintenance of the
person alleged, as a result of mental disorder, to present a likelihood
of serious harm to others or himself, or to be gravely disabled, and the
address of each such person if known to the petitioner.
(e) A statement that the professional staff of the evaluation and
treatment facility has examined and analyzed respondent's condition and
finds that as a result of mental disorder respondent presents a
likelihood of serious harm to himself or others or is gravely disabled.
(f) A statement that the respondent has been advised of the need for
voluntary treatment and that the professional staff of the facility has
evidence that he has not in good faith volunteered.
(g) A statement that the facility providing intensive treatment is
certified to provide such treatment by the Department of Social and
Health Services of the State of Washington.
(h) A statement that there is no less restrictive alternative to
detention in the best interests of respondent or others, or that a less
restrictive alternative is sought and a specification of what that alternative is.
(i) A demand that a probable cause hearing be held within 72 hours
after provisional acceptance at the evaluation and treatment facility,
excluding Saturdays, Sundays, and holidays, unless the person is sooner
released, on the issue of whether the respondent shall be detained for an
additional 14 days' involuntary treatment or whether such person shall be
treated under less restrictive alternatives.
(j)The petition shall be in substantially the following form:
SUPERIOR COURT OF WASHINGTON
FOR (_______________) COUNTY
In re the Detention of: ) No. __________
)
) PETITION FOR FOURTEEN-
) DAY INVOLUNTARY
) TREATMENT
)
Respondent. ) RCW __________
(Petitioner(s)), ___ mental health professional for _____________
County, ___ member(s) of professional staff of _______________________
(agency or facility), ___ prosecuting attorney for _________________
County pursuant to RCW 10.77.090, alleges that:
(Respondent), residing at (address) in (city or town), is a
___ single ___ married ___ widowed ___ divorced ___ male ___ female
age _____. (Respondent's) occupation is ______________________________
______________________________________________________________________
______________________________________________________________________
The professional staff of the evaluation agency or facility has
examined respondent's condition and finds that as a result of mental
disorder (respondent) presents:
___ a likelihood of serious harm to him/herself,
___ a likelihood of serious harm to others,
___ a likelihood of serious harm to the property of others,
___ is gravely disabled.
The facts upon which the allegations of this petition are based are as follows:
______________________________________________________________________
______________________________________________________________________
(use back of page if necessary)
The person(s) legally responsible for the care, support, and
maintenance of (respondent) and their relationship to him are, so far as
known to the petitioner, as follows: (Give names, addresses, and
relationship of persons named as respondents.)
______________________________________________________________________
(use back of page if necessary)
The respondent has been advised of the need for, but has not accepted
voluntary treatment.
The facility providing intensive treatment is certified to provide
such treatment by the Department of Social and Health Services.
The petitioner(s) request(s) that a hearing be held before (time and
date) unless the respondent is sooner released, to determine whether
(respondent) ___ shall be detained for 14 days' involuntary treatment
because there is no less restrictive alternative to detention in the best
interest of respondent or others, or ___ shall be required to comply with
the following less restrictive alternative:
______________________________________________________________________
______________________________________________________________________
Dated this _______day of ____________________, 19____.
_________________________________________________________
Petitioner __ Physician __ MHP __ Prosecuting Attorney __
_________________________________________________________
Petitioner __ Physician __ MHP __ Prosecuting Attorney __
_________________________________________________________
_________________________________________________________
Address
Sworn and Subscribed on__________________________________________
____________________________________________________
Notary Public for the State of Washington
Residing at ________________________________________
My commission expires on____________________________
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