Petition And Affidavit Seeking Ex Parte Order Requiring Involuntary Examination Form - Hernando County, Florida Page 3
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4Petition and Affidavit Seeking Ex Parte Order Requiring Involuntary Examination
(Page 3)
11. The following steps were taken to get the PERSON to go to a hospital for mental health care:
_______________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
These steps did not work because: _____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
12. I believe that the PERSON is unable to determine for himself/herself, why the examination is necessary because:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
13. I believe that the PERSON has a mental illness which will keep the PERSON from being able to meet the ordinary
demands of living because: __________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
14. I believe that without care or treatment, the PERSON is likely to suffer from neglect or refuse to care for himself/ herself,
because: _______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
15. I believe that this lack of care or neglect will lead to the PERSON hurting himself or herself because:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
16. Can family or close friends now provide enough care to avoid harm to the PERSON?
Yes
No, If not, why?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
CONTINUED
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