Order Authorizing Emergency Examination And Treatment {2F-P-527}

IN THE FAMILY COURT OF THE SECOND CIRCUIT STATE OF HAWAI`I IN THE INTEREST OF RESPONDENT-SUBJECT ) FC-M NO. ) ) ORDER AUTHORIZING EMERGENCY ) EXAMINATION AND TREATMENT ) ) ) ) ) SUBJECT222S INFORMATION: (NAME) (CURRENT ADDRESS) (PERMANENT ADDRESS) (BIRTHDATE OR AGE) (PHONE NO) (PHONE NO) (SEX) (MARITAL STATUS) The attached application was filed in this court. Judge was informed of the allegations regarding the above-named subject on , at . M., and it appears there is probable cause to believe the following: American LegalNet, Inc. www.FormsWorkFlow.com page 2 Continued The subject of this proceeding is: [ ] mentally ill [ ] suffering from substance abuse, and is imminently dangerous to: [ ] self [ ] others and is in need of care and/or treatment. The court issued an oral order as set forth in the application on , at . M. IT IS HEREBY ORDERED that any police officer or other suitable person to take the subject into custody and deliver him/her to: [ ] Queen222s Medical Center and/or Hawai`i State Hospital [ ] Maui Memorial Medical Center Emergency Room for admission to the Molokini Unit for emergency examination and treatment. IT IS FURTHER ORDERED that the above-named subject shall be discharged from the above-mentioned facility within forty-eight (48) hours from the time of his/her admission unless the subject voluntarily agrees to further hospitalization or a proceeding for court-ordered evaluation and/or hospitalization is initiated. If forty-eight (48) hours expires on a Saturday, Sunday or holiday, the time is extended to noon of the next court day. If it is found that the subject no longer meets the criteria for emergency hospitalization, he/she shall be discharged unless the subject is under criminal charges, in which case he/she shall be returned to the custody of a law enforcement officer. (Date) (Judge222s Signature) (Judge222s Name) American LegalNet, Inc. www.FormsWorkFlow.com