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Superior Court of Ca Los Angeles Form
Concern:
Medical/mental health service(s) requested:
Child’s attorney’s name:
Telephone:
Identify attachments, if any:
URGENT/EMERGENT. Checking this box necessitates both of the following:
a)
The Judicial Officer will be contacted directly, day or night, by the court pediatrician as soon as possible (within
eighteen hours) at this court email
.
b) This signed referral form will be emailed to BOTH court pediatricians with high priority: Email to
[email protected] AND...
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