Fill and Sign the Mc 110 Petition for 30 Day Commitment 12 87 Fill in Mental Commitment Forms

AS 47.30.730 Page 1 of 2 MC-110 (12/87)(cs) PETITION FOR 30-DAY COMMITMENT IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity ) for the Hospitalization of: ) ) ________________________ ______, ) Case No. Respondent. ) ) PETITION FOR 30-DAY COMMITM ENT As mental health professionals who have examined the respondent, the petitioners allege that: 1. The respondent is mentally ill and as a result is likely to cause harm to himself/herself or others. gravely disabled and there is reason to believe that the respondent's mental condition could be improved by the course of treatment sought. 2. The evaluation staff has considered, but has not found, any less restrictive alternatives available that would a dequately protect the respondent or others. 3. is an appropriate treatment facility for the respondent's condition and has agreed to accept the respondent. 4. The respondent has been advised of the need for, but has not accepted, voluntary treatment. The petitioners respectfully request the cour t to commit the respondent to the above- named treatment facility fo r not more than 30 days. The facts and specific behavior of the res pondent supporting the above allegations are: AS 47.30.730 Page 2 of 2 MC-110 (12/87)(cs) PETITION FOR 30-DAY COMMITMENT Case No. The following persons are prospective witnesses, some or all of whom will be asked to testify in favor of the commitment of the respondent at the hearing: Date Signature Printed Name Title DateSignature Printed Name Title Note: This petition must be signed by tw o mental health professionals who have examined the respondent, one of whom is a physician. AS 47.30.730(a).