Riese Petition And Declaration Of Service Regarding Capacity To Give Informed Consent {LASC MH 006}

MH 006 - RIESE PETITION AND DECLARATION OF SERVICE REGARDING CAPACITY TO GIVE INFORMED CONSENT TO MEDICATION WIC§ 5332 (b). This form is used in the Superior Court of California, County of Los Angeles to request a court determination on whether a patient can provide informed consent for psychiatric medication. The petition is filed by a treating physician when a patient, who is being held under Welfare and Institutions Code (WIC) Sections 5150, 5250, 5260, 5270.15, 5270.70, or 5352.1, is exhibiting symptoms of a mental disorder and is unable to make informed decisions about their medication. The petition outlines the patient’s current mental condition, including specific symptoms and the recommended classes of psychiatric medications. The physician must document efforts to explain the risks, benefits, and alternatives of the medication to the patient, as well as the patient’s responses to these explanations. The physician must also provide their professional opinion on whether the patient lacks awareness of their mental disorder, is unable to understand the risks and benefits of treatment, or cannot rationally participate in the decision-making process regarding medication. If the physician determines that the patient lacks the capacity to consent, they request that the court appoint an advocate or legal counsel to represent the patient in a medication capacity hearing. The petition further asks the court to issue an order declaring the patient incapable of giving informed consent for medication during their period of commitment. The petitioner provides available dates for a facility-based hearing, which must be held within three days of filing the petition, as required by WIC § 5334(a). By signing the form under penalty of perjury, the petitioner certifies that the statements are true and that a copy of the petition has been served to the patient. Mandatory Form. www.FormsWorkflow.com