Application For Court Approval Of 5 Day Detention {MC-615}

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Hospitalization of: Respondent. Date of Birth: ) ) ) ,) ) ) ) Case No. APPLICATION FOR COURT APPROVAL OF 5-DAY DETENTION I hereby apply for court approval of emergency detention of the respondent named above for more than 48 hours but no longer than 5 days at and hereby certify: 1. I am employed as the administrator of the approved public treatment facility named above. The respondent was first detained on the Application for 48-Hour Emergency Commitment at (time) a.m. p.m. on (date) The need for further emergency treatment exists. The Application for 48-Hour Emergency Commitment and timely Certificate of Need for Emergency / Involuntary Commitment are attached. Within 24 hours after commitment, I gave the respondent a copy of the Application for 48-Hour Emergency Commitment, Certificate of Need for Emergency / Involuntary Commitment, and Notice of Right to Counsel, and I provided a reasonable opportunity for the respondent to consult with legal counsel as required by AS 47.37.180(f). 2. 3. 4. 5. Date Administrator in Charge of the Facility Type or Print Name MC-615 (5/10)(cs) APPLICATION FOR COURT APPROVAL OF 5-DAY DETENTION AS 47.37.180 American LegalNet, Inc. www.FormsWorkFlow.com