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and is currently being held pursuant to 3. Check at least one box: a. Petitioner is illegally confined for the following reason: b. a. b. c. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. (SIGNATURE OF PETITIONER OR PERSON REQUESTING WRIT ON PETITIONER'S BEHALF) PETITION FOR WRIT OF HABEAS CORPUS—LPS ACT (Mental Health) Form Approved for Optional Use Judicial Council of California HC-002 [Rev. September 1, 2018] Other (specify) : SUPERIOR COURT OF CALIFORNIA, COUNTY OF IN THE MATTER OF (NAME) : Petitioner FOR COURT USE ONLY CASE NUMBER: PETITION FOR WRIT OF HABEAS CORPUS—LPS ACT ATTORNEY OR PARTY WITHOUT ATTORNEY STATE: ZIP CODE: CITY: STREET ADDRESS: FIRM NAME: NAME: TELEPHONE NO.: FAX NO.: E-MAIL ADDRESS: ATTORNEY FOR ( name): STATE BAR NUMBER: HC-002 1. Petitioner is being unlawfully restrained of liberty at (specify name of treatment facility): by (specify name of agency and treating psychiatrist) : 2. Petitioner was admitted to the treatment facility on (date): W & I, § 5150 (72-hour hold) W & I, § 5270.15 (30-day cert.) W & I, § 5350 (conservatorship) W & I, § 5250 (14-day certification) W & I, § 5260 (2d 14-day certification) W & I, § 5352.1 (temporary conservatorship) W & I, § 5300 (180-day post certification) Petitioner has been denied the following rights without good cause (Welf. & Inst. Code, §§ 5325, 5325.1, and 5326): 4. Petitioner requests that this court (check all that apply): Issue a Writ of Habeas Corpus to the director of the facility named in item 1, commanding that the petitioner be brought before this court at a specified time and place. Order the facility to release petitioner from restraint. Order that all rights to which petitioner is entitled as a patient be observed. d. Grant such other relief as this court deems appropriate. Date: (TYPE OR PRINT NAME) Page 1 of 1 www.courts.ca.gov. MM/DD/YYYY Print this form Save this form Clear this form For your protection and privacy, please press the Clear This Form button after you have printed the form.