In the Superior Court of the State of California
For the County of ____

The People

For the Best Interest and Protection of

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Order for Care,
Hospitalization,
or Commitment

as a ,

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and Concerning

and

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⎪

, Respondents

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The petition dated ________, alleging that ________, having been presented to this court on the ________ day of ________, 20__, and an order of detention issued thereon by a judge of the superior court of this county, and a return of the said order:

And it further appearing that the provisions of Sections 6250 to 6254, inclusive, of the Welfare and Institutions Code have been complied with;

And it further appearing that Dr. ________ and Dr. ________, two regularly appointed and qualified medical examiners of this county, have made a personal examination of the alleged ________, and have made and signed the certificate of the medical examiners, which certificate is attached hereto and made a part hereof;

Now therefore, after examination and certificate made as aforesaid, the court is satisfied and believes that ________ is a ________ and is so ________.

It is ordered, adjudged, and decreed:

That ________ is a ________ and that _he

* (a) Be cared for and detained in ________, a county psychiatric hospital, a community mental health service, or a licensed hospital for the care of persons with mental health disorders until the further order of the court, or

* (b) Be cared for at ________, until the further order of the court, or

  * (c) Be committed to the State Department of State Hospitals for placement in a state hospital, or

  * (d) Be committed to a facility of the Department of Veterans Affairs or other agency of the United States, to wit: ________ at ________.

It is further ordered and directed that ________ of this county, take, convey, and deliver ________ to the proper authorities of the hospital or establishment designated herein to be cared for as provided by law.

Dated this ________ day of ________, 20__.

_____ _____ Judge of the Superior Court

* Strike out when not applicable.