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APPLICA1....N FOR EXTENDL INVOLUNTARY ...EATMENT _
.
MENTAL HEALTH PROCEOURES ACT OF 1976
(SECTION 3031 ^/c, 9 q 7 ( ,1 k.7n lJ
I' ~'~~L I' -, 7
NAME OF PATIENT
IT.... blink. below may b. completed following "million.)
MIDDLE
AOE
.3
88U NO,
C- Q
NAME OF 88U
,0 P,
NAME OF FACILITY L!0:.
Cat- i /,
ADMISSION DATE
AOMIS810N NO.
INSTRUCfIONS
1. Part I must be completed by the petitioner. The petitioner will generally be the director,
acting director. or appropriate designated staff within the facUity where the patient is being
treated.
2. Part II is to be completed by persons authorized by the director of the facility to explain
rights to the patient.
3, Part III is to be completed by a physician who has personally examined the patient.
4. Part IV is to be completed by a judge or a Mental Health Review Officer.
5. If additional sheets are needed at any point. note on this form the number of pages which
are attached.
6. Attach a copy of the treatment plan and the 302 form prior to its delivery to the court.
7. The patient should receive a copy of MH 784.A. a copy of this petition. and a copy of Part I
or the 302 form when this 303 form is med with the court.
8. If the patient is subject to criminal proceedings/detention. briefly describe below,
IMPORTANT NOTICE
ANY PERSON WHO PROVIDES ANY FALSE INFORMATION ON PUR.
POSE WHEN COMPLETING THIS FORM MAY BE SUBJECf TO CRIMINAL
PROSECUTION AND MAY FACE CRIMINAL PENALTIES INCLUDING
CONVICfION OF A MISDEMEANOR.
PAoe I Dr 4
MH 784. 7.82
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PART I
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REQUEST FOR CERTIFICATION
has actcd in such manner as to cause
(NAME 0' PATIENT'
a re'ponsi[,le party to bfHeve that helsh ',severely, mentally disa['led as specified in the allached 302 form, Helshe
was admilled to l. l' ~ -<, . (-' "" for involuntary emergency examination
~ A ACILI Y
and treatlllelll on .1.1 ';).~ CI L( at I '. '1'I( under Section 3U2. Hc/she was examined by
I tD E~ CEMACT TIME I
and was found to be in need of continued treatment.
(NAME OF PHYSICIAN)
I respectfully request, therefore, that helshe be certified by the court for extended involuntary emergency treatment
under Section 313.
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ITITLE OF PETITIONER)
PART II
THE PATIENT'S RIGHTS
I afftrm that I have informed the patient of the action I am taking and have e"lained to the tat,ent these
procedures and hislher rights as described in form MH 784.A, I beHeve that he/she: 'n understands does not
understand these rights, "7'"
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PART III
PHYSICIAN'S EXAMINATION
I hereby affum that I examined t.l.Lk' i ( {\\ ;:yi i'S (l t:'.
I / CNAME OF PATIENT)
::) ;) "i 7 if to determine if he continued to be severely mentally ill and in need of treatment.
IOArEI
on
Findings:
U
RESULTS OF EXAMINATION
(Describe your fllldings in detail Use additional sheets if necessary,)
Nul:, ;/n ;'1c'f/:'W} (Utf '5.'(11(,',) (l.t
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, Treatment Need.
if.necessary.)
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(Describe the treo ent needed by the. .tient, Continue or. .dltionalaheeu
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In my opinion: (Cheek A or B)
~he patient continues to be severely mentally disabled and in need of treatment.
B. 0 The patient is not severely mentally disabled and in need of involuntary treatment,
6lA:~ t'
PART IV
CERTIFICATION BY THE COURT FOR EXTENDED INVOLUNTARY
EMERGENCY TREATMENT - SECI'ION 303
In the Court of C ~\'\\ vl-H'I'\ P il "'-4
of
CA.o11. b~(
County
In reo
term, 19_
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No.
Certification for Extended Treatment
This 2 g-fl day of -.R. /. ,~,^,lvV . 199.J after hearing and consideration of:
(Details of findings. Include detaUs as to what type a d why treatment is needed. Attach reports, testimony,
etc,)
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PAGE 3 01 .
IContlnuld On Nut 'a;,'
MH 18' . 7.82
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The court finds that the patient I 1)( I is D is not I severely mentally disabled and in need .
of treatment. Accordingly, the COUrl orders that: (Check A or D)
A, [RJ
v ( cj(A.~ fl1 "- +,' U,i(
(NAME OF PATIENT)
receive:
o outpatient,
D partial hospitalization,
[8l inpatient treatment
which is the least restrictive treatment setting appropriate for the patient at
~v--R ~( /-1.._ - A (....j as a severely mentally disabled
(NAME OF l~~'~)
person pursuant to the provisions of Section 303 f the Mental Health Procedures Act
of 1976 for a period of ' 2-0 ,
eND TO EXCEED 20 DA I
D. 0 The person is not subject to involuntary treatment.
I have explained to the patient that if his/her conference was before a Mental Health Review Officer
he/she may petition the court for a review of any decisions reached at this conference.
(Check appropriate block)
\ZJ The patient was represented by [(\,.1.",
~~~ ~'J 6vJ~ J}ft
IN ME ANO ADORE OF A TORNEV) .
o The patient declined representation.
for the court/~, /JIJtI1~
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(TITLE)
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PAGE 4 014
MH 784 . 7.82
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APPLICATION FOR
INVOLUNTARY EMERGENCY EXAMINATION
AND TREATMENT
LAST
Mental Health Procedures Act of 1976
Section 302
leted foUowin admission.)
FIRIT
AGE
lEX
MIDDLE
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NAME OF COUNTY 'ADORAM
NAME OF BSU
AU NO.
LArvt4d", (oll;afy 111/1- 1'tR-
HAME OF FACILITY ADMISlION OAT
INSTRUCTIONS
1. Pan I must be completed by the person who believes the patient Is in need of treatment.
If this person is not a physician, police officer, the County Administrator or hb delegate,
he or she must request authorization or a warrant through the County Administrator.
2. If the authorization or a warrant rhrough rhe County Administrator is required, call or visit
the Office of the County Administrator. AuthoriJation to take a patient for examination
without a warrant is to be documented in Pan II, If a warrant is required, Pan III must be
completed by the County Administrator or a person designated by the Administrator to
sign the warrants.
3. When the patient is taken to the examination facility, the rights described in Form MH 783.A
must be explained. Pan IV should be signed by the person who explains these rights to the
patient,
4. Pan V is to be completed by the County Administrator (or reprelentative) or by the Director
of the Facility (or representative) upon arrival of the patient at the facility.
S. Pan VI is to be completed by the examining physician,
6. If additional sheets are required at any point in completing this form, note on this form
the number of additional sheets which are attached.
7. If the patient is subject to criminal proceedings/detention, briefly describe below.
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'AGE' of 7
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Describe in det~u the specific beha!ior within the last 30 days which supports your beliefs (include locarion,
date and iime whenever possible, and state who observed the behavior):
.fee. m1-4<.l.c j S-l-e}CAw--....f-
I understand that I.mu:. be required to testify at a coun hearing concerning the informarion I gave,
On the basis of the information I gave above, I believe that \J ,'c. k i L, M...+,.~ P-k..
. I, (,a"SON" NAMal
is in need of involuntary examination and treatment, I request that: (Check A or B _ Norice that B can _
be checked by a physician, a police officer, the County Administrator or his/her delegate),
A.
2a
The County Administrator issue a warrant authorizing a policeman or some-
one representing the County Administrator to take the patient to a facUity
for examination and treatment,
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'RINT NAME AND ADDRESS Of "''''LICANT TILIPHONE NO.
Ie"
B.
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That this facility examine the patient to determine his!her need for treat-
ment.
SIGNATURE OF 'HVIICIAN. POLICE OFFICER.
COUNTY ADMINISTRATOR, OR REPRESENTATIVE
DATI!
PRINT NAME AND TITLE OF PHYSICIAN. POLICE OFFICER.
COUNTY ADMINISTRATOR OR REPRESENTATIVE
TELEPHONE NO.
ADDRESS
PAGe 30f7
MH 713 . 7.12
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fl\RT III
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WARRANT
(Check A or B)
A,
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Based upon representations made to me by
I hereby order that
CNAME OF AFFLICANll
.ha1J be taken to
CNAME OF FER.ON)
and examined at and if required,
CNAME OF FACILITY)
shall be admilled to a facUity designated for treatment for a period of time not to exceed
120 hours,
Name of facUity designated for treatment if other than the facUity conducting the examination:
SIGNATURE OF COUNTY AOMINISTRATOR OR HIS/HER REFRESENTATIVE
OATE ANO TIME
PAINT NAME OF COUNTY ADMINISTRATOR OR HIS/HER REPRESENTATIVE
B.
o
DENIAL OF WARRANT
The request of the petitioner for a warrant is denied:
SIGNATURE OF COUNTY AOMINISTRATOR OR REFRESENTATIVE
DATE
PART IV
THE PATIENT'S RIGHTS
(NAME OF FACILITYI
1 explained his rights to him/her. These rights are described in Form MH 783-A. I believe that he/she:
[]2!'does understand these rights. I/I"~ -fo ~ I:>~ Ye":>
I affirm that when the patient arrived at
LG-H-
o docs not understand these rights.
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~ SIG~XFLAINING RIGHTS
a{;).;)./CJc(
DATE
~V((-K Alh~
PRINT NAME OF PERSON EXPLAINING RIGHTS
!9Q'-/Date
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TREATIiENT NOTES .
Client I/,dJ.u f/.Q/;/AdJ/:
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EXI'LANATION OF RIGHTS UNDER INVOLUNTARY EMERGENCY
TREATMENT
(302)
INAME OF FACI~ITYI
a responsible person has observed your conduct and feels that you present a clear danger to yourself lOr 1<,
other people, Within two hours from now you will be examined by a physician. If the doctor finds that
you do not need treatment, you will be returned to whatever place you desire within reason. If the doctut
agrees that you arc mentally ill and clearly in danger of harming yourself or someone else, you will be
admitted to a facility designated by the County Administrator for a period of treatment of up to 120
hours, While you arc under examination or in treatment, you have the following rights:
You have been brought to
1-6-1+
bCI-.llht'
1. You must be told specifically why you were brought here for emergency examinath,n,
2. You may make up to 3 completed phone calls immediately.
3. You have the right to communicate with others,
4. You may give to the facility the names of 3 people whom you want contacted, and the)'
will contact them and keep them informed of your progress while here,
5. The County Mental Health Administrator must take reasonable steps to assure that whil,.
you are detained, the health and safety needs of any of your dependents are met and thaI
your personal property and your premises where you live are looked after.
6. You will be provided treatment which is necessary to deal with the emergency so as to
protect your health and safety and that of other additional treatment may be provided
with your consent.
7. When you are no longer in need of treatment or in 120 hours, whichever comes sooner,
you will be discharged unless you agree to remain at the treating facility voluntarily or
unless the director of the facility asks the court to extend your treatment for a longer
period of time.
In addition to the above rights, the attached nill of Rights applies to you. You will receive a longer more
detailed version of Department of Public Welfare R gulations on r' hts wit~il} 72 hours after your commit-
ment. If you do not understand these rights 11'" c.1< I:.,..t!~
will be pleased to explain them further to you. (NAME OF MENTAL HEALTH WORKERI
MH 783A "87
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BILL OF RIGHTS
{
YOU HAVE A RIGHT TO BE TREATED
WITH DIGNITY AND RESPECT
YOU SHALL RETAIN ALL CIVIL RIGHTS THAT
HAVE NOT BEEN SPECIFICALLY CURTAILED BY
ORDER OF COURT
1. You have the right to unrestricted and private communication insids and outside this facility
Including the following rights:
& To peaceful assembly and to join with other patients to organize a body of or
participate "In patient government when patient government has been determined to be
feasible by the facility,
b, To be assisted by any advocate of your choice in the assertion of your rights and to
seo a lawyer in private at any time,
c. To make complaints and to have your complaints heard and adjudicated promptly.
d. To receive visitors of your own choice at reasonable hours unless your treatmsnt
team has determined In advance that a visitor would seriously Interfere with your or
others treatment or welfare,
e, To receive and send unopened letters and to have outgoing letters stamped and mailed.
Incoming mail may be eKamlned for good reason in your presence for contraband.
Contraband means specific property which entails a threat to your health and welfare
or to the hospital community,
f. To have access to telephones designated for pstient use.
2.
You have the right to practice the religion of your choice or to abstain from religious
practice I.
You have the right to keep and to use personal possessions. unless It has been determined
that .peclflc per.onsl property Is contraband. The reasons for imposing any limitation and
It. .cope must be clearly defined. recorded and eKplained to you. You have the right to
.ell .ny personal article you make and keep the proceeds from Its sale.
You have the right to handle your personal affairs Including making contracts. holding a
driver's license or professional license. marrying or obtaining a divorce snd writing a will.
You have the right to participate In the development and review of your treatment plan
You have the right to receive treatment in the least restrictive setting within the facility
nece18ary to accomplish the treatment goals.
You have the right to be discharged from the facility as soon as you no longer need care
and treatment
3,
4.
II.
II.
7.
8.
You have the right not to be subjected to any harsh or unusual treatment
If you have been Involuntarily committed In accordance with civil court proceedings, and
you are not receiving treatment. and you are not dangerous to yourself or others. and you
can .urvlve safely In the community, you have the right to be discharged from the facility.
10. You have a right to be paid for any work you do which benefits the operation and
maintenance of the facility In accordance with eKlstlng Federal wage and hour regulations,
9.
01'''.
MH 782 . 2/87
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TREATMENT NOTES
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Client t/i~jl' ltaiJAaJ
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IIQNA'UIIR 0' COIINTY AllMINllTIIATOII 011 IIEPRIUNTATIVI
DATI
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PART III (
WAlUtANl'
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(Check A or B)
A. ~
Baltd I,plln replClcntlllons
I hereby order thu
I 0
and eumlned at ,.1..-:: ~~",:.f.,R and if required,
-"'=" tA AIITI'
shall be .dmlllec:\ 10 " C"cUlty dcs~n"ted for ue"tment Cor" period of dme not co eltceed
no hOWl,
/
Name ~C (~cUhy dulgnued Cor treAtment If other thall Ihe f"cUlty conducting tho examwclon I
B.
.J!,
"~~~U~:~' ~UN~Yrll~INIITIIA~OIl 011 HISlHllIlIlPlIlSeNTATIVI
L;:. bkbe.Ac-....^ '
'''IH AMI 0' COUNTY AllI.IINIIT"ATOII 011 HIII"a" ...,IISClNTATIVIi
DENIAl. OF WARRANT
The rUlluelt oC the pedlloner Cor I wsrflnt Is denied.
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A . TIMI
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PAATIV
'I'HE PATIENT'S IUGHTS
I ,,(flrm lhll when lhe p"tient "rdved at
(NAM' o. MOILITVI
11"pl"lned hi, r~lhllto him/her, Thlle r1;hu l.I'e described in Form MH 783.A, 1 believe that he/she;
CI dOClllndeul"nd th... rlghu,
o dOli noc undenc~nd theM r!&he..
"O"'ATU'" 0' PIlliON IXPLAINING AIGI<4TS
OATI
rAINT NAM" Of ,cnSON c)(rL^'HINQ MIQHT.
'''111 &.f 1
hlH 713 . 7..2
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CARTA DE DERECHOS
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TIENE DERECHO A SER TRATADO
CON DIGNIDAD Y RESPETO
RETENDRA TODOS LOS DERECHOS NO RESPECIFICAMENTE
PROHIBIDOS POR ORDEN DE LA CORTE
1. Tiene derecho a comunlcarse en prlvado sin restricciones dentro y fuera de esta Instltuci6n,
incluvendo los sigulentes derechos:
a
A ser asemblelsta pasivo y unlrse a otros paclentes para organlzar 0 particlpar en el
gobierno de los pacientes, sl eso se ha dstermlnado factible por la institucl6n.
b, Ser asistido por cualquler defensor seleccionado por ud V consultar con un abogado
en privado a cualquler hora
c. Quejarse V hacer qus sus quejas sean oldas V adjudicadas prontamente,
d Reciblr visltantes de su preferencia a horas razonables, a menos que su team de
tratamiento haya determlnado de antemano que los vlsltantes pueden Interferir
serlamente con su blenestar y tratamiento y el de otros.
e, Reciblr y enviar cartas sin que las abran V tener las cartas de salldas selladas y
enviadas por correo. EI correo entrante puede ser examinado en Stl presencia, sl hay
sospecha razonable gue exista contrabando, Contrabando qulere decir una propiedad
especlfica que constltuye una amenaza a su salud y bienestar 0 la comunidad del
hospital
f. Tener acceso a los telefonos designados para el uso del paclente.
2. Tiene derecho a practicar su rellgi6n 0 abstenerse de participar en pnlcticas religlosas.
Tlene derecho a retener y usar sus posesiones personales, a menos que alguna propiedad
suva se determine contrabando, La raz6n por la cual se Ie impone Iimltacl6n liene que ser
definida, registrada y explicada a Ud Tiene derecho a vender artfculos personales y retener
las ganancias de venla
4. Tlene derecho a manejar sus asuntos personales, Incluvsndo hacer contrato, tener IIcencia
de manejo 0 Iicencia de profesi6n, casarse, divorciarse y escriblr un testamento.
3.
5. Tlene derecho a participar en el desarrollo y la revisi6n de su plan de tratamlento,
6. Tiene derecho a recibir tratamiento de la manera menos rectrictiva dentro de la Inslituci6n,
pero sin que eso afecte los prop6sitos del tratamlento,
7. Tiene derecho a ser dado de alta tan pronto no necesite ni el cuidado ni el tratamlento.
8. Tiene derecho a no ser sujetado rudamente 0 tratado de manera lnapropiada
9. Si ha estado cometido involuntariamente de acuerdo con el procedimiento de la corte civil
pero no estc\ reciblendo tratamlento, ni es peligroso para si mismo y otros V puede
sobrevivir seguramente en la comunidad: tiene derecho a ser dado de alia
10. Tiene derecho a que Ie paguen por cualquier trabajo que beneflcie la operaci6n y el
mentenimlento de esta institucion, de acuerdo con el reglamento federal sobre salario,
o 194711
MH 782 . 2187
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EXPLlCACION DE LOS DERECHOS BAJO
TRATAMIENTO INVOLUNTARIO
(302)
,
Usted ha sido traido a
porque una
(HOMBRE DE LA INSTITUCION)
persona ha observado su conducta y cree que ud. presenta un peligro presente y claro para si
mismo como para otros. Si el doctor determina que ud, no necesita tratamiento, serl devuelto
a cualquier lugar que desee, si es razonable. Si el doctor est~ de acuerdo que ud. es un enfermo
mental y c1ara'!lente csta' en pcligro de hacerse daii'o a si mismo y a otros, entonces, sera' admitido
ella institucion designada par el Administrador del Condado par un periodo de tratamiento que no
exceda 120 horas. Mientras sea exam nado 0 bajo tratamiento, tiene los siguientes derechos:
t. Tienen que decirle porque Ie trajeron aqui 'para hacerle una examinaci6'n fl~ica.
2.
Puede completar hasta tres lIamadas tclc'fonicas inmediatamente.
3.
4.
Tiene derecho a comunicarse con otros.
Puede darle a la institucio'n el nombre de tres personas con las cuales ud. desea que
se pongan en contacto. La institucio'n se pondrl en contacto con ellos y les informart
d ' "'
acerca e su progreso mlenuas permanezca aqul.
5,
EI Administrador de Salud Mental del Condado tiene que tamar pasos razonables para
asegurar que mientra este detenido, la seguridad y salud de sus dependientes tanto
corm su propiedad personal y ellocal que ocupa, estaran bajo vigilancia.
Serl sometido a un tratamiento necesario para proteger su salud y seguridad y cual-
quier ouo tratamiento que sea necesario bajo su consentimiento.
6.
7.
Cuando ya no necesite tratamiento 0 hayan pasado 120 horas -10 que venga primero-
serf dado de alta a menos que ud. estt! de acuerdo a permancer en Ia institucion
voluntariamente, 0 que el director de la institucion peticione a Ia corte extender su
periodo de tratamiento,
En adici&'n alas susodichos derechos, la Carta de Derechos se aplica a Ud, Recibira' una
versi&'n mis larga y detallada de los derechos civiles que aparecen en el Reglamento de
Bienestar Pl1blico dentro de 72 horas de ser admitido. Si ud. no entiende estos derechos,
se los explicar:' con gusto.
CHOMBRE OEL TRABAJADOR DE SALUD MENTAL)
MH 7B3A,S . 2/87
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PART V
ACfIONS TAKEN TO PROTECf THE
PATIENT'S I"!TEREST
I affirm that to,the best of my knowledge and belief the following actions which wcre taken
constituted all reasonable steps needed to assure that while the patient is detained the health and safety
needs of any his/her dependents are met and that his/her persolUl property and the premises he/she occupies
are secure.
Describe the actions tak.en below. Use additional sheets if required.
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IIGNATURE OF COUNTY AOMINISTRATORIREFRESENTATIVE
OR THE OIRECTOR OF THE FACILITY OR REFRESENTAT'VE
o/~~~A;Y
(J, Vl e-/( A I b~
'RINT NA"!IE OF COUNTY ADMINISTRATOR'RE'RESENTATIVEI
DIRECTOR OF THE FACILITY OR REPRESENTATIVE
'AGE e or '7
MH 713 . '.82
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PART II
Authorization for Transportation to an Approved FacUity
for Examination Without a Warrant
(Under Section 302(a) (2))
For use in emergency situationl when the Administrator orally authorizes a responsible
person to take a paticnt to a dcsignatcd facUity for cxamination without a warrant. Whcn such
authorization of a County Administrator or dcsigncc is obtaincd by tclcphonc, thc documcntation
bclow is rcquircd:
NAMI Of PilliON IIIQUIITINO AUTHOllltATION
OATlITIMI Of CALLlAUTHOIIIZATION
IIIASON fOil OIlAL AUTHOIIIZATION
NAMI ANO T1TLI Of PillION OIVINo THI AUTHOIIIZATION
I swear or affum that I pcrsonally obtaincd authorization for tranlporting thc paticnt to
from thc abovc-named
(fACILITY)
Administrator or his/hcr representative and that I wu advised that documentation of this tclephone
call is maintained in the Administrator's fLIes.
NAMI AND ADDRESS
"ELATION.HI' TO PATIENT
'AGE. of 7
MH 713 . '.Ia
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PHYSICIAN'S EXAMINATION
{
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I arnrm that ll;ctl !f7lrrlJtJlt
~'I(fltl!
and wu examined by me at
XACT liMO
arrived at this facility at
3"/3 f!tI
(EXACT 11 ME'
RESULTS OF EXAMINATION
PINDINGS. lDac,lbe oar rlndl. In det.lI. U.. .ddUlo... sheela II _.r ~
TREATMEl\-r NEIlDllllllDacrlbe the treatment aceded b the tlm!. Conll... an .ddltl....1 sheela II........ ~
~ C1 ra Ctt't!.r; {/?f/ id
In my opinion: (Check A or B)
A. [2( The patient Is scverety mental1y disabled and In need of treatmenL He
should be admitted to a faclllty designated by the County Administrator for
a period of treatment not to exceed 120 hours.
B.
o
The patient is not In need of emergency Invotuntary trcatmenL He shal1 be
returned to a place which he shal1 reasonably designate.
~/l1 ~
SIGNATURE OF EXAMINING PHYSICIAN
..J ;;J.!}/9y
DATE
UN ~W nrr
PRINT NAME OF EXAMINING PHYSICIAN
PAGE 7 OF 7
MH 713 . 10/511
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IMPORTANT NOTICE
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ANY PERSON WHO PROVIDES ANY FALSE
INFORMATION ON PURPOSE WHEN HE
COMPLETES nlls FORM MAY BE SUBJECT
TO CRIMINAL PROSECIJTION AND MAY
FACE CRIMINAL PENALTIES INCLUDING
CONVICTION OF A MISDEMEANOR.
Part I
APPLICATION
~
h
:e,
I believe that \/,'c.k,' L, M..h'cA.J{,
l'E~S~EI
1',:
is severely mentally disabled: (Check and complete all applicable for this patient,) c-.
A person is severely mentally disabled when, as a result of mental ll,lness.=ii1s/her
capacity to exercise self-control, judgment and discretion in the conduct of his/her affai'a and
social relations or to care for his/her own personal needs is so lessened that he/she poses a cfe'ar and
present danger of harm to others or to himself or herself,
o
dear and present danger to others shall be shown by establishing that within the put
30 days the person has inflicted or attempted to inflict serious bodily harm on
another and that there is reasonable probability that such conduct will be repeated,
A clear and present danger of harm to others may be demonstrated by proof that the
person hu made threats of harm and has committed acts in furtherance of the threat
to commit harm; or
dear and present danger to himself shall be shown by establishing that within the
put 30 days;
o (i)
m'(ii)
o (ill)
the person hu acted in such manner u to evidence rhat he/she would be'
unable, without care, supervision and the continued assistance of others, to
satisfy his/her need for nourishment, personal or medical care, shelter, or
self'protection and safety, and that there is reasonable probability that death,
serious bodily injury or serious physical debilitation w6uld ensue within
30 days unless adequate treatment were afforded under the act; or
the person has attempted suicide and that there is reasonable probability
of suicide unless adequate treatment is afforded under this act, For the
purpose of this subsection, a clear and present danger may be demonstrated
by the proof that the person has made threats to commit suicide and has
committed acts which are in furtherance of the threat to commit suicide; or
the person has substantially mutilated himselflherself or attempted to
mutilate himself/herself substantially and that there is the reasonable
probability or multilation unless adequate treatment is afforded under this
act. For the purposes of this subsection, a clear and present danger shall be
established by proof that the person has made threats to commit mutilation
and has commiltedacts which are in furtherance of the threat to commit
mutllation,
PAGE 20'7
fAH 783 . 7.12