pjc-family-2024-lib

I NVOLUNTARY C OMMITMENT

PJC 245.1

Answer “Yes” or “No.” Answer: _______________ If you answered “Yes” to Question 1, then answer Question 4. Otherwise, do not answer Question 4. QUESTION 4 Do you find by clear and convincing evidence that, as a result of that mental illness, INITIALS OF PROPOSED PATIENT suffers severe and abnormal men tal, emotional, or physical distress? Answer “Yes” or “No.” Answer: _______________ If you answered “Yes” to Question 4, then answer Question 5. Otherwise, do not answer Question 5. QUESTION 5 Do you find by clear and convincing evidence that, as a result of that mental illness, INITIALS OF PROPOSED PATIENT is experiencing substantial mental or physical deterioration of his ability to function independently, which is exhibited by his inability, except for reasons of indigence, to provide for his basic needs, including food, clothing, health, or safety? Answer “Yes” or “No.” Answer: _______________ If you answered “Yes” to Question 5, then answer Question 6. Otherwise, do not answer Question 6. QUESTION 6 Do you find by clear and convincing evidence that, as a result of that mental illness, INITIALS OF PROPOSED PATIENT is unable to make a rational and informed decision as to whether or not to submit to treatment? Answer “Yes” or “No.” Answer: _______________

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