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Order for Initial Detention (ORDTCOC) - Page 1 of 5 Or Order for DCR to File Petition Family, Guardian, or Conservator (ORDFAOT) WPF MP 01.0700 (03/2018) RCW 71.05.201 Superior Court of Washington County of _________________ In re the detention of Respondent (person to be detained) DOB _____________________________________ Petitioner Case No . Joel’s Law Order [ ] For DCR to File Petition for Ass isted Outpatient Behavioral Health Treatment (ORDFAOT) [ ] For Initial Detention (ORDTCOC) [ ] Clerk’s Action Required: Order, paragraph 2 Basis On ____________________(date) , a Petition was filed by an immediate family member /s for the involuntary detention of the Respondent. On ____________________ (date) , the Court found sufficient evidence to support the allegation and ordered the Designated Crisis Responder agency to provide a written sworn statement describing the basis for the decision not to seek initial detention and a copy of all information material to that decision within one judicial day . Findings of Fact Jurisdiction: The Court has jurisdiction over the person and subject matter of this action. The Court has reviewed the following: [ ] Petition for Initial Detention by Immediate Family Member, Guardian , or Conservator. [ ] Declaration /s of: ______________________________________________________________________ ______________________________________________________________________ Cause No. ________________________ Order for Initial Detention (ORDTCOC) - Page 2 of 5 or Order for DCR to File Petition Family, Guardian, or Conservator (ORDFAOT) WPF MP 01.0700 ( 07 /2019 ) RCW 71.05.201 ______________________________________________________________________ ______________________________________________________________________ . [ ] Written sworn statement of the Designated Crisis Responder. [ ] Other: ______________________________________ ___________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ __ _______________________________________________________________________. A review of the Petition shows that there is sufficient evidence to conclude that Petitioner is an immediate family member, the guardian , or the conservator. A review of the Petition and all of the supporting documentation shows sufficient evidence to support the allegation /s as follows: ____________________________________________________________________________ ________________________________________________________________________ ____ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ________________________ ____________________________________________________. The Respondent has a mental disorder or substance use disorder history consisting of (insert facts specific to the case): ____________________________________________________________________________ ___ _________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _______________________________ _____________________________________________ ____________________________________________________________________________. An immediate family member, guardian , or conservator of the Respondent filed a Petition in accordance with RCW 71.05.201. [ ] There is probable cause to order the Designated Crisis Reponder to file a petition for assisted outpatient behavioral health treatment because the Respondent as a result of a [ ] mental disorder [ ] substance use disorder: [ ] Has been committed by a court to detention for involuntary behavioral health treatment during the preceding thirty -six months; [ ] Is unlikely to voluntarily partiparticipate in outpatient treatment without an order for less restrictive alternative treatment based on a history of n onadherence with threat or in view of the respondent’s current behavior; [ ] Is likely to benefit from less restrictive alternative treatment; and [ ] Requires less restrictive alternative treatment to prevent a relapse, decompensation, or deterioration that is likely to result in the respondent presenting a likelihood of serious harm or the respondent becoming gravely disabled within a reasonably short period of time. Cause No. ________________________ Order for Initial Detention (ORDTCOC) - Page 3 of 5 or Order for DCR to File Petition Family, Guardian, or Conservator (ORDFAOT) WPF MP 01.0700 ( 07 /2019 ) RCW 71.05.201 [ ] There is probable cause to support an order to detain the Respondent pursuant t o the petition because the Respondent, as a result of a [ ] mental disorder [ ] substance use disorder: [ ] presents a likelihood of serious harm to him/herself; [ ] presents a likelihood of serious harm to others; [ ] presents a likelihood of serious harm to the property of others; or [ ] is gravely disabled (check all that apply): [ ] is in danger of serious physical harm resulting from a failure to provide for his /her essential human needs of health or safety. [ ] manifests severe deteriora tion in routin e functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety . [ ] The Respondent has refused or failed to ac cept appropriate evaluation and treatment voluntarily. [ ] A Designated Crisis Responder has not filed a petition for initial detention of the Respondent under RCW 71.05.150 or 71.05.153. Conclusions of Law On the basis of the foregoing Findings of Fact, the Court makes the following Conclusions of Law: 1. The Court has jurisdiction over the Respondent and subject matter of this action; 2. Probable cause exists to order: [ ] the Designated Crisis Responder to file a petition for assisted outpatient beh avioral health treatment (RCW 71.05.201); [ ] the Respondent be detained to an [ ] evaluation and treatment facility [ ] secure withdrawal management and stabilization facility [ ] approved substance use disorder treatment program for no more than 7 2 hours (excluding Saturdays, Sundays , and legal holidays) of evaluation and treatment pursuant to ch. 71.05 RCW ; 3. Respondent has refused or failed to accept evaluation and treatment voluntarily. Order [ ] The Designated Crisis Reponder is directed to File a Petition for Assisted Outpatient Behavioral Health Treatment. [ ] For Initial Detention: 1. The Respondent shall be detained for initial detention by a Designated Crisis Responder for _______________ _________ County and delivered to a facility or emergency room determined by the Designated Crisis Responder (DCR) pursuant to ch. 71.05 RCW . 2. The clerk of the court is directed to transmit a copy of this Order to the Designated Crisis Responder Agency. Law Enforcement shall apprehend and deliver the Resp ondent to a facility or emergency room determined by the DCR. This Order expires 180 days from the date of issuance. Cause No. ________________________ Order for Initial Detention (ORDTCOC) - Page 4 of 5 or Order for DCR to File Petition Family, Guardian, or Conservator (ORDFAOT) WPF MP 01.0700 ( 07 /2019 ) RCW 71.05.201 3. Unless further evaluation and treatment is sought, the Respondent shall be released from the evaluation and trea tment facility not more than 72 hours from the time of detention. The computation of such 72 hours shall exclude Saturdays, Sundays , and holidays. 4. At the time the Respondent is taken into custody, the Respondent shall be served with a copy of the origin al (1) Petition for Initial Detention and any Declarations filed with the Petition, (2) Declaration of the DCR and any materials filed with said Declaration, (3) this Order and the Order directing action and today’s Hearing, and (4) Notice of Rights. Not ice of Rights THE RESPONDENT IS GIVEN NOTICE OF THE FOLLOWING RIGHTS: 1. You have the right to communicate with an attorney immediately and the right to have an attorney represent you before and at any court hearing and to have such attorney appointed if y ou cannot afford one and the right to know the name and address of said attorney. You are entitled to contact an attorney of your choosing, or in place thereof , an attorney will be appointed to represent you. 2. You have the right to remain silent , as any statement you make may be used against you. 3. You have the right to present evidence and to cross -examine witnesses who may testify about you at any probable cause hearing. 4. You have the right to a judicial hearing in a court of law within the next 72 hours (excludes Saturday, Sunday , and legal holidays) to determine whether there is probable cause to commit you for further mental health treatment for up to 14 days of inpatient or 90 days of outpatient treatment for the reason that you are a person whos e mental disorder presents a likelihood of serious harm to yourself or others or that you are gravely disabled. 5. You have the right to apply for voluntary admission for treatment of a mental disorder. 6. You have the right, within 24 hours of admission, to be examined and evaluated by a licensed physician and a licensed mental health professional and shall receive such treatment and care as your condition requires for the period that you are detained. 7. You have the right to wear your own clothes and to keep and use your own personal possessions, except when deprivation is essential to protect your safety or the safety of others. 8. You have the right to keep and be allowed to spend a reasonable sum of your own money for canteen expenses and small purcha ses. 9. You have the right to have access to individual storage space for your private use. 10. You have the right, at the time you are involuntarily admitted to an evaluation and treatment facility, that reasonable precautions will be taken to inventory and safeguard your personal property. A copy of the inventory, signed by the staff member making it, will be given to you and will also be open to inspection by any responsible relative, subject to any limitations you may impose. “Responsible relative" in cludes the guardian, conservator, attorney, spouse, parent, adult child, or adult brother or sister of the person. Cause No. ________________________ Order for Initial Detention (ORDTCOC) - Page 5 of 5 or Order for DCR to File Petition Family, Guardian, or Conservator (ORDFAOT) WPF MP 01.0700 ( 07 /2019 ) RCW 71.05.201 The facility will not disclose the contents of the inventory to any other person without your consent or an order of the court. 11. You have the right to dispose of property and sign contracts unless you have been adjudicated incompetent in a court proceeding directed to that particular issue. 12. You have the right to have visitors at reasonable times. 13. You have the right to have reasona ble access to a telephone, to both make and receive confidential calls. 14. You have the right to have ready access to letter writing materials, including stamps, and to send and receive uncensored correspondence through the mail. 15. You have the r ight to refuse psychiatric medication, including antipsychotic medications, beginning 24 hours prior to the probable cause hearing, or the performance of electroconvulsive therapy or surgery, except emergency lifesaving surgery, unless ordered by a court o f competent jurisdiction under the appropriate legal standards and procedures. (This does not apply to minors detained per RCW 71.34.) 16. If antipsychotic medications are administered in an emergency, you have the right to a review of that decision withi n 24 hours. 17. You have the right not to have psychosurgery performed on yourself under any circumstances. 18. You have the right to receive the necessary papers pursuant to the law. Dated: ______________________ _____________________________ _____________ Judge / Court Commissioner