Adhs/dbhs Form Mh-110 - Petition For Court-Ordered Treatment
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3ADHS/DBHS FORM MH-110
PETITION FOR COURT-ORDERED TREATMENT
Gravely Disabled Person
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF
In the Matter of
)
)
MH
)
)
PETITION FOR COURT-
)
ORDERED TREATMENT
)
(Pursuant to A.R.S. § 36-533)
re: Mental Health Services
)
Danger to Self/Others or
)
Persistently or Acutely Disabled or
)
Gravely Disabled
STATE OF ARIZONA
)
) ss
COUNTY OF
)
)
Petitioner
, being first duly sworn/affirmed, alleges that:
(Medical Director)
1.
is, as a result of a mental disorder:
danger to self
danger to others
persistently or acutely disabled
gravely disabled
and in need of treatment.
2. The court-ordered treatment alternatives that are appropriate and available are:
outpatient treatment [A.R.S. § 36-540(A)(1)].
combined inpatient and outpatient treatment [A.R.S. § 36-540(A)(2)].
inpatient treatment [A.R.S. § 36-540(A)(3)].
3. The person is unwilling or is unable to accept treatment voluntarily.
4. A summary of the facts supporting the above allegations is in the attached reports of
examining physicians.
5. The person is residing or present in this county, or is admitted to an institution pursuant to
an order of a court of competent jurisdiction sitting in this county, or who was committed by
an Arizona tribal court, which order of commitment was duly domesticated pursuant to
A.R.S. § 12-1702 et seq.
ADHS/BHS Form MH-110 (9/93)
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