The order for evaluation shall be in substantially the following form:
In the Superior Court of the State of California
for the County of _____
The People of the State of California
Concerning
and
Respondents
No. _____
Order
for
Evaluation
or Detention
The People of the State of California to
:
(Peace officer, counselor in mental health, or
other official appointed by the court)
The petition of ____ has been presented this day to me, a Judge of the Superior Court for the County of ____, State of California, from which it appears that there is now in this county, at ____, a person by the name of ____, who is, as a result of mental disorder, a danger to others, or to himself, or gravely disabled.
Now, therefore, you are directed to notify ____ to submit to an evaluation at ____ on the ____ day of ____, 19_, at __ o’clock __m.
____ shall be permitted to be accompanied by one or more of his relatives, friends, an attorney, a personal physician, or other professional or religious advisor.
The individual or individuals who accompany ____ may be present during the evaluation if so requested by ____.
*Provision for Detention for Evaluation
If the person fails or refuses to appear for evaluation when notified by order of this court, you are hereby directed to detain said ____ or cause him to be detained at ____ for a period no longer than 72 hours, excluding Saturdays, Sundays, and holidays if evaluation services are not available on those days, for the purposes of evaluation.
I hereby direct that a copy of this order together with a copy of the petition be delivered to said person and his representative, if any, at the time of his notification; and I further authorize the service of this order at any hour of the day or night.
Witness my hand, this ____ day of ____, 19_
Judge of the Superior Court
*This paragraph is applicable only if the person to be evaluated fails or refuses to appear for evaluation after having been properly notified.
Return of Order
I hereby certify that I received the above order for the evaluation of ____ and on the ____ day of ____, 19_, personally served a copy of the
order and of the petition on ____ and the professional person in charge of the ____, a facility for treatment and evaluation, or his designee.
Dated: ____, 19_.
Signature and Title
