Fill and Sign the Mc 400 Notice of Respondents Arrival at Evaluation Facility Form

MC -400 ( 11/17 )(cs) AS 47.30.700 -715; .870; .915(5) NOTICE OF RESPONDENT'S ARRIVAL AT EVALUATION FACILITY IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity ) for the Hospitalization of: ) ) , ) Case No. Respondent. ) ) NOTICE OF RESPONDENT'S ARRIVAL AT EVALUATION FACILITY [Instructions to Facility : Upon arrival of the r espondent at your facility, y ou must fill out this notice and fax it to (1) the court where the MC -305 Order was issued ; and (2) the court nearest your facility ; and ( 3) the Public Defender Agency nearest your facility . If the respondent arrives between 9:00 am and 3:00 pm, fax this notice no later than 3:30 pm on the same business day. If the respondent arrives between 3:00 pm and 9:00 a m, or at any time during the weekend or on a holiday, fax this notice no later than 9:30 am on the first business day after respondent’s arrival. ] 1. TO CLERK OF CO URT : Anchorage at 264 -0598 Glennallen at 822 -3601 Palmer at 746 -4151 Angoon at 788 -3108 Haines at 766 -3148 Petersburg at 772 -3018 Aniak at 675 -4278 Homer at 235 -4257 St. Mary’s at 438 -2819 Bethel at 543 -4419 Hoonah at 945 -3637 Seward at 2 24 -7192 Chevak at 858 -7230 Juneau at 463 -3788 Sitka at 747 -6690 Cordova at 424 -7581 Kake at 785 -3152 Skagway at 983 -3801 Cr aig at 826 -3904 Kenai at 283 -8535 Tok at 883 -4367 Delta Junc. at 895 -4204 Ketchikan at 225 -7849 Unalakleet at 624 -3118 Dillingham at 842 -5746 Kodiak at 486 -1660 Unalaska at 581 -2809 Emmonak at 949 -1535 Kotzebue at 442 -3974 Utqiaġvik at 852 -4804 Fairbanks at 452 -9216 Naknek at 246 -7418 Valdez at 835 -3764 Fort Yukon at 662 -2824 Nenana at 832 -5841 Wrangell at 874 -35 09 Galena at 656 -1546 Nome at 443 -2192 Yakutat at 784 -3257 2. TO PUBLIC DEFENDER : Anchorage at 868 -2588 Ketchikan at 225 -1382 Juneau at 465 -324 7 Bethel at 543 -2153 Fairbanks at 458 -6802 3. PLEASE TAKE NOTICE THAT THE RESPONDENT ARRIVED AT: Alaska Psychiatric Institute PeaceHealth Ketchikan Medical Center Ba rtlett Regional Hospital Yukon -Kuskokwim Health Corporation Fairbanks Memorial Hospital Other Date and time of arrival Date and time of this fax Date Signature Printed Name and Title