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Fill and Sign the Mc 615 Application for Court Approval of 5 Day Detention 5 10 Mental Commitment Form

Fill and Sign the Mc 615 Application for Court Approval of 5 Day Detention 5 10 Mental Commitment Form

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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Hospitalization of: ) ) ) , ) Case No. Respondent. ) ) Date of Birth: ) APPLICATION FOR COURT APPROVAL OF 5-DAY DETENTION I hereby apply for court approval of emergen cy detention of the respondent named above for more than 48 hours but no longer than 5 days at and hereby certify: 1. I am employed as the administrator of the approved public treatment facility named above. 2. The respondent was first detained on the Application for 48-Hour Emergency Commitment at (time) a.m. p.m. on (date) 3. The need for further emergency treatment exists. 4. The Application for 48-Hour Emergency Commitment and timely Certificate of Need for Emergency / Involuntary Commitment are attached. 5. Within 24 hours after commitment, I gave the respondent a copy of the Application for 48-Hour Emergency Commitment , Certificate of Need for Emergency / Involuntary Commitment, and Notice of Right to Counsel , and I provided a reasonable opportunity for the respondent to consult with legal counsel as required by AS 47.37.180(f). Date Administrator in Charge of the Facility Type or Print Name MC-615 (5/10)(cs) AS 47.37.180

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