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Order Regarding Capacity To Consent To Or Refuse Antipsychotic Medication RI-PR053 - California

Order Regarding Capacity To Consent To Or Refuse Antipsychotic Medication Form. This is a California form and can be used in Probate Riverside Local County .
 Fillable pdf Last Modified 5/29/2014
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE INDIO 46-200 Oasis St., Indio, CA. 92201 RIVERSIDE 4050 Main St., Riverside, CA 92501 TEMECULA 41002 County Center Dr., #100, Temecula, CA 92591 RI-PR053 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): IN THE MATTER OF: CASE NUMBER: ORDER REGARDING CAPACITY TO CONSENT TO OR REFUSE ANTIPSYCHOTIC MEDICATION WELFARE AND INSTITUTIONS CODE § 5334 The Petition Regarding Capacity to Consent To Or Refuse Antipsychotic Medication came on for hearing as follows (check boxes c, d, e, and f to indicate personal presence): a. Judicial Officer (name): b. c. Hearing date: Hearing location: Time: 9990 County Farm Road, Riverside, CA 92503 26520 Cactus Ave., Moreno Valley, CA 92555 47-915 Oasis Street, Indio, CA 92201 1A 08 T1 31 Other (specify): Department d. Petitioner (name): e. Attorney for petitioner (name): f. Attorney (Name): (Address): Patients Rights Advocate for the patient: (Telephone): g. Patient wa s not present. Page 1 of 2 Approved for Optional Use Riverside Superior Court RI-PR053 [Rev. 05/02/14] ORDER REGARDING CAPACITY TO CONSENT TO OR REFUSE ANTIPSYCHOTIC MEDICATION (WELFARE AND INSTITUTIONS CODE § 5334) WIC § 5334 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF: CASE NUMBER: THE COURT FINDS The patient has the capacity to refuse consent to treatment by antipsychotic medication, and may not be required to take the medication. By clear and convincing evidence, the patient lacks the capacity to refuse consent to treatment by antipsychotic medication, and may be required to accept the medication. The evidence relied upon in making this determination is as follows: The Declaration of Treating Physician Regarding Capacity to Consent To Or Refuse Antipsychotic Medication The testimony of the Expert Witness (name): The testimony of the patient Other: This determination shall remain in effect until the expiration of the present involuntary hold, until capacity is restored, or by subsequent determination, whichever is sooner. Amended letters of Conservatorship shall issue reflecting the above order. Date: (JUDICIAL OFFICER) Page 2 of 2 Approved for Optional Use Riverside Superior Court RI-PR053 [Rev. 05/02/14] ORDER REGARDING CAPACITY TO CONSENT TO OR REFUSE ANTIPSYCHOTIC MEDICATION (WELFARE AND INSTITUTIONS CODE § 5334) WIC § 5334 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com
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