General Assembly: 76 (1996 Regular GA) - Chapter 1225 - Appointment of physician form


Published: 1996

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CH. 1225 INVOLUNTARY HOSPITALIZATION OF THE MENTALLY ILL

CHAPTER 1225 APPOINTMENT OF PHYSICIAN FORM

IN THE SUPREME COURT OF IOWA

ORDER

IN THE MATTER OF THE RULES FOR THE INVOLUNTARY HOSPITALIZATION OF THE MENTALLY ILL

772

By action of this court en bane, the Rules For the Involuntary Hospitalization of the Men- tally III are hereby amended as shown in the attached Exhibit "A," effective July 1, 1996.

Dated this third day of April, 1996.

THE SUPREME COURT OF IOWA

Is/Arthur A. McGiverin ARTHUR A. McGIVERlN, Chief Justice

773 INVOLUNTARY HOSPITAUZATION OF THE MENTALLY ILL CH. 1225

EXHIBIT "A:' HOSPITAUZATION OF MENTALLY ILL APPOINTMENT OF PHYSICIAN FORM

IN THE IOWA DISTRICT COURT IN MID FOR _________ COUN1Y,IOWA

IN THE MATTER OF:

ALLEGED TO BE SERIOUSLY MENTALLY IMPAIRED,

Respondent.

) ) ) ) ) )

No. ______________________ _

APPOINTMENT OF PHYSICIAN PURSUANT TO IOWA CODE SECTION 229.8, THE CODE.

STATE OF IOWA, ________ COUN1Y:

To _____________ , a regular practicing physician eOf-f =========,Cb60UunHfj~'7' ~Io~\i¥ava:

An ~plieation is due farm of law hav=.ng been laid befare the (Gourt) (Judieial Hespitalii!a tion Referee) of this County, You are advised that an application has been filed in the Iowa District Court for County alleging that Respendent is seriously mentally impaired, and is a fit sHbjeet far eustody and treatment, needing medical care and treatment within the meaning of the applicable sections of Iowa Code chapter 229. yyou are hereby ~poisted APPOINTED by said (Court) (Judieial Hospitalization Referee) to visit or see said respondeat and to mal~e personal eKamiBation teuehiBg the tFHth of the allegations of said applieation and touellmg respondeat's aetHal eondition this court to conduct a personal examination of the above-named person for the purpose of determining whether the person is seriously mentally impaired as defined in Iowa Code section 229.1 (14). After conducting such an examination. you shall provide this court with a written report of your medical findings and conclusions.

* NOTE TO EXAMINING PHYSICIAN:

If the respondent has been detained pursuant to Iowa Code section 229.11(2), The Code, your examination must be conducted within 24 hours of this date. If the respondent has been detained pursuant to section 229.11 (1) or (3). your examination must be conducted within 48 hours of this date. Furthermore. your written evaluation report is to be filed with the Clerk of this Court prior to the hospitalization hearing scheduled pursuant to Iowa Code section 229.8(3) (a). See Iowa Code § 229.10(2). An informational copy of the report may be directly transmitted by facsimile to the Clerk at the following number: ( ) . Transmission by facsimile does not constitute filing.

Dated this day of .19

Judicial Hospitalization Referee

Judge of the Judieial Distriet of Iewa or Judieial Hospitalii!atien Referee

Judge of the --- Judicial District

°SerondUllDmlbered paragraph in fonn prior to amending was not shown as strickenin Court Order as probably iU:ended