B) The patient [ ] is able [ ] is not able to understand the risks or benefits of medication
or alternative treatments; (Explain)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
C) The patient [ ] is able [ ] is not able rationally to understand and evaluate information
regarding informed consent, and otherwise participate in the treatment decision; (Explain)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
8. Medication must be administered in order to alleviate the acuteness of the patient's current
symptomatology.
9. It is alleged on information and belief that the patient is required to have an advocate/legal
counsel appointed and is unable to retain such services.
WHEREFORE, Petitioner prays that:
1. An advocate be appointed to represent the patient in the medication
capacity hearing. The advocate may be an attorney privately retained by the patient or an
employee of the Los Angeles County Department of Mental Health attached to the Patient's
Rights Office;
2. The Court issue an order finding that the patient is incapable of giving informed consent
during the patient's commitment under the aforementioned applicable Welfare and Institutions
Code Sections.
3. For all other further and proper relief.
Page 3 of 4
Rev. 9/6/13