Cal. WIC § 5262
This is the official text of Cal. WIC § 5262, part of California’s Welfare and Institutions Code — governs public social services, juvenile justice, and mental health/developmental disability services.
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Official statutory text
A second notice of certification for imminently suicidal persons is required for all involuntary 14-day intensive treatment, pursuant to this article, and shall be in substantially the following form:
To the Superior Court of the State of California
for the County of ______
The authorized agency providing 14-day intensive treatment, County of _________, has custody of: _________
Name ____________
Address ____________
Age ____________
Sex ____________
Marital status ____________
Religious affiliation ____________
The undersigned allege that the above-named person presents an imminent threat of taking his own life.
This allegation is based upon the following facts:
This allegation is supported by the accompanying affidavits signed by ____________.
The above-named person has been informed of this allegation and has been advised of, but has not been able or willing to accept referral to, the following services:
We, therefore, certify the above-named person to receive additional intensive treatment for no more than 14 days beginning this day of (Month) , 19__, in the intensive treatment facility herein named ________.
We hereby state that a copy of this notice has been delivered this day to the above-named person and that he has been clearly advised of his continuing legal right to a judicial review by habeas corpus, and this term has been explained to him.
(Date)
Signed
Countersigned Representing intensive treatment facility
To the Superior Court of the State of California
for the County of ______
The authorized agency providing 14-day intensive treatment, County of _________, has custody of: _________
Name ____________
Address ____________
Age ____________
Sex ____________
Marital status ____________
Religious affiliation ____________
The undersigned allege that the above-named person presents an imminent threat of taking his own life.
This allegation is based upon the following facts:
This allegation is supported by the accompanying affidavits signed by ____________.
The above-named person has been informed of this allegation and has been advised of, but has not been able or willing to accept referral to, the following services:
We, therefore, certify the above-named person to receive additional intensive treatment for no more than 14 days beginning this day of (Month) , 19__, in the intensive treatment facility herein named ________.
We hereby state that a copy of this notice has been delivered this day to the above-named person and that he has been clearly advised of his continuing legal right to a judicial review by habeas corpus, and this term has been explained to him.
(Date)
Signed
Countersigned Representing intensive treatment facility
Status: in_force · Read it on the official government site
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