Statute · California Welfare and Institutions Code

Cal. Welf. & Inst. Code § 5252 — Certification for Intensive Treatment

Cal. Welf. & Inst. Code § 5252

Type: Statute
Source: California Welfare and Institutions Code
Jurisdiction: California
Current through: Nov 2, 2026 (California Legislative Counsel)

A notice of certification is required for all persons certified for intensive treatment pursuant to Section 5250 or 5270.15, and shall be in substantially the following form (strike out inapplicable section):

Citator

Cal. Welf. & Inst. Code § 5252 — Certification for Intensive Treatment is in force in the current edition of the Code, and nothing recorded condemns it.

The authorized agency providing evaluation services in the County of _______ has evaluated the condition of:
Name __________
Address __________
Age __________
Sex __________
Marital status__________
We the undersigned allege that the above-named person is, as a result of mental disorder or impairment by chronic alcoholism:
(1) A danger to others. (2) A danger to himself or herself. (3) Gravely disabled as defined in paragraph (1) of subdivision (h) or subdivision (l) of Section 5008 of the Welfare and Institutions Code.
The specific facts which form the basis for our opinion that the above-named person meets one or more of the classifications indicated above are as follows:
(certifying persons to fill in blanks) __________ __________ __________ [Strike out all inapplicable classifications.]
The above-named person has been informed of this evaluation, and has been advised of the need for, but has not been able or willing to accept treatment on a voluntary basis, or to accept referral to, the following services:
__________ __________ __________ __________ __________
We, therefore, certify the above-named person to receive intensive treatment related to the mental disorder or impairment by chronic alcoholism beginning this ____ day of (Month) , 19__, in the intensive treatment facility herein named ______.
(Date)
Signed__________ Signed__________ Countersigned __________(Representing facility)__________
I hereby state that I delivered a copy of this notice this day to the above-named person and that I informed him or her that unless judicial review is requested a certification review hearing will be held within four days of the date on which the person is certified for a period of intensive treatment and that an attorney or advocate will visit him or her to provide assistance in preparing for the hearing or to answer questions regarding his or her commitment or to provide other assistance. The court has been notified of this certification on this day.
__________Signed__________