West Virginia > Statewide > Circuit Court > Mental Hygiene
Authorization And Order To Return Escaped Patient To Mental Health Facility SCA-MH-920CMO - West Virginia
| Authorization And Order To Return Escaped Patient To Mental Health Facility Form. This is a West Virginia form and can be used in Mental Hygiene Circuit Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
NOTICE TO RETURN ESCAPEE TO MENTAL HEALTH FACILITY IN RE: Involuntary Hospitalization of Case No. ________- MH -___________________________________________ RESPONDENT AUTHORIZATION AND ORDER: TO RETURN ESCAPED PATIENT TO MENTAL HEALTH FACILITY [W.Va. Code: 27-7-5] TO THE SHERIFF OF ______________________ COUNTY, WEST VIRGINIA: Pursuant to the provisions of West Virginia Code: 27-7-5, YOU ARE HEREBY COMMANDED to take into custodyand to transport back to the ____________________________________________________________ mental health facility thefollowing patient who has escaped therefrom: Name of Patient: ___________________________________________________________________________________Patients Description: ____________________________________________________________________________________________________________________________________________________________________________________ Patients Last Known Address: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ A person who is taken into custody under this notice and the provisions of West Virginia Code: 27-7-5, may be detained, butnot incarcerated in a jail or penal institution, for a period not in excess of fourteen (14) hours, pending return to the mental healthfacility named above. Given under my hand this _________ day of ______________________________________, 20 _______. ____________________________________________________________ CHIEF MEDICAL OFFICER OF FACILITY SCA-MH 920CMO / 5-01
|
|||||||
