Form Cc Dc 13 PDF Details

In the exploration of the nuances surrounding mental health crises and intervention, the CC-DC 13 form serves as a crucial legal document within the state of Maryland. Functioning under the guidelines established by the Maryland Code, Health-General Article § 10-620 et seq., this form is utilized for petitioning an emergency evaluation of an individual believed to be in a state of mental distress that poses a danger to themselves or others. Designated for use in both the Circuit and District Courts of Maryland, the form facilitates a process whereby a petitioner—often a relative, health professional, or concerned individual—can request the court to order an emergency psychiatric assessment. The document meticulously outlines the necessity for the petitioner to provide comprehensive details concerning their relationship with the evaluee, any previous attempts at intervention, and the specific behaviors prompting the petition. Furthermore, upon submission, the court assesses the petition and, when deemed appropriate, authorizes law enforcement to transport the individual in question to a designated emergency facility for evaluation, all within a framework that balances the need for immediate intervention with respect for the individual's legal rights. This form not only embodies the legal procedure for initiating urgent mental health evaluations but also highlights the broader commitment to public safety and individual well-being intrinsic to Maryland's approach to mental health care.

QuestionAnswer
Form NameForm Cc Dc 13
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmaryland emergency evaluation, petition emergency requests make, maryland emergency petition form 2020, petition emergency requests get

Form Preview Example

CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR

City/County

Located at

Case No.

 

Court Address

In the Matter of

 

 

PETITION FOR EMERGENCY EVALUATION

 

(Maryland Code, Health-General Article § 10-620 et seq.)

The Petitioner,

, requests that this Court order an

 

Name of Petitioner

emergency evaluation of

and

Name of Person to be evaluated (Evaluee)

in support of this Petition states as follows:

1. Petitioner: Address

 

 

 

 

 

Cell Phone/Pager #

 

 

Home Phone

 

Work Phone

Relationship to or interest in evaluee

 

 

 

 

2. Evaluee: Address

 

 

 

 

DOB

Sex

Race

Ht.

Wt.

Hair

Eyes

Complexion

Driver's License No.

 

 

 

Other

 

3. If not Petitioner, name of spouse, child, parent, or other relative, or other individual interested in the evaluee:

Name

 

Relationship

 

Address

 

 

 

Home Phone

 

Work Phone

 

4. A petition for emergency evaluation of the evaluee was filed previously on

Date(s)

and was

granted

denied.

 

5. The evaluee has been hospitalized in the past at the following facilities:

When

Where

Diagnosis

When

Where

Diagnosis

6. The evaluee currently is receiving psychiatric treatment from:

 

Name

Address

Phone

Name

Address

Phone

7. The evaluee has been prescribed the following medication for his/her mental disorder.

8.The evaluee IS IS NOT taking the medication as prescribed OR taking medication as prescribed.

I do not know whether the evaluee is

9.The evaluee is demonstrating the following behavior that leads me to conclude that he/she currently has a mental disorder:

(Attach additional sheet if necessary)

10. The evaluee presents a danger to the life or safety of the evaluee or others because:

(Attach additional sheet if necessary)

11. The evaluee has access to the following firearms/weapons:

I hereby certify and declare under the penalties of perjury that the matters and facts stated in this Petition are true to the best of my knowledge, information, and belief.

Date

Petitioner

TO THE PETITIONER: You may be required to appear before the Court. If an evaluation is ordered, it would be helpful if you could accompany the evaluee to the emergency facility and provide facility authorities with all information that is pertinent to this Petition. A petitioner who, in good faith and with reasonable grounds, submits or completes the petition for emergency evaluation is not civilly or criminally liable for submitting or completing the petition.

CC-DC 13 (Rev. 11/2008)

(front)

ENDORSEMENT AND ORDER

In the matter of the emergency evaluation of

(Case No), the Petitioner having presented to the Court and the Court having reviewed the Petition and considered all pertinent data presented, the Court:

Finds probable cause to believe that the named individual (evaluee) has shown the symptoms of a mental disorder and presents a danger to the life or safety of the evaluee or others and, therefore, ORDERS that any peace officer take into custody and transport the evaluee to the nearest emergency facility, for examination by a physician within six hours after arrival at the facility and, if in the physician's opinion necessary, for emergency care and treatment; provided that the facility may not keep the evaluee for more than 30 hours under this Order but is not precluded from voluntary or involuntary admission in accordance with Maryland Code, Health-General Article.

Denies the Petition, finding no probable cause.

Date

Judge

Maryland Code, Health-General Article §§ 10-622 and 10-624 provide as follows:

A.Duties of Peace Officer

1.Caution to Petitioner. A peace officer shall explain to a physician, psychologist, clinical social worker, licensed clinical professional counselor, clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse practitioner, a licensed clinical marriage and family therapist, or a health officer or designee of a health officer, who presents a petition to the peace officer:

a.the serious nature of the petition; and

b.the meaning and content of the petition.

2.Delivery to Facility. A peace officer shall take an evaluee to the nearest emergency facility if the officer has a petition that:

a.has been endorsed by a court within the last 5 days; or

b.is signed and submitted by a physician, psychologist, clinical social worker, licensed clinical professional counselor, clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse practitioner, a licensed clinical marriage and family therapist, or a health officer or designee of a health officer, or peace officer.

3.Documentation of Delivery. A peace officer shall complete a Return of Service by Peace Officer form (CC-DC 27) and have an agent for the emergency facility sign the form.

4.Remaining with Evaluee.

a.After a peace officer takes an evaluee to an emergency facility, the officer need not stay unless, because the evaluee is violent, a physician asks the officer's supervisor to have the officer stay.

b.A peace officer shall stay until the officer's supervisor responds to the request for assistance.

5.Return of Service. A peace officer shall file a completed return of service with the Court issuing the Endorsement and Order immediately after an evaluee is delivered to an emergency facility or immediately

after expiration of the five-day period for taking the evaluee into custody.

BDuty of Supervisor. A supervisor shall allow a peace officer to stay with a violent evaluee.

C.Duties of Emergency Facility

1.Documentation of Delivery. An agent of the emergency facility shall sign the Return of Service by Peace Officer form completed by a peace officer transporting an evaluee to the facility.

2.Examination. If a physician asks that a peace officer stay, a physician shall examine the evaluee as promptly as possible to determine whether the evaluee meets the requirements for involuntary admission. In any event, a physician shall examine an evaluee within six (6) hours after an officer brings the evaluee to the facility.

3.Release or Admission. Promptly after an examination, an evaluee shall be released unless the evaluee:

a.asks for voluntary admission; or

b.meets the requirements for involuntary admission.

4.Detention Period. An emergency evaluee may not be kept at an emergency facility for more than thirty (30) hours.

CC-DC 13 (Rev. 11/2008)

(back)

How to Edit Form Cc Dc 13 Online for Free

You'll be able to fill out maryland emergency petition form 2020 effortlessly in our PDFinity® online tool. Our tool is constantly evolving to deliver the very best user experience achievable, and that is due to our commitment to continuous development and listening closely to customer comments. This is what you'd have to do to get going:

Step 1: Click on the "Get Form" button in the top area of this webpage to open our editor.

Step 2: The editor will let you change the majority of PDF files in a range of ways. Modify it by writing your own text, correct what's already in the document, and add a signature - all within a few clicks!

Be mindful while filling in this pdf. Ensure that every single blank is completed properly.

1. It's vital to fill out the maryland emergency petition form 2020 accurately, hence pay close attention while filling in the areas that contain these specific fields:

cc dc 13 completion process detailed (portion 1)

2. Once your current task is complete, take the next step – fill out all of these fields - If not Petitioner name of spouse, A petition for emergency, The evaluee has been hospitalized, When, When, Where, Where, The evaluee currently is, Name, Name, Address, Address, The evaluee has been prescribed, Dates, and Diagnosis with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling in section 2 in cc dc 13

Those who use this PDF frequently get some things wrong when completing Where in this section. Be sure to go over whatever you enter here.

3. Completing ENDORSEMENT AND ORDER, In the matter of the emergency, Finds probable cause to believe, Date, Judge, Maryland Code HealthGeneral, A Duties of Peace Officer, and Caution to Petitioner A peace is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Step no. 3 for submitting cc dc 13

Step 3: Check that the details are correct and then click on "Done" to continue further. Try a 7-day free trial account at FormsPal and gain instant access to maryland emergency petition form 2020 - accessible inside your personal cabinet. At FormsPal.com, we endeavor to make sure all of your information is stored private.