California Code, Welfare and Institutions Code - WIC § 5227

The order for evaluation shall be in substantially the following form:

In the ․․․․․․․․․․ Court of the State of California for the County of ․․․․․․․․․․.

The People of the State of California to :

(Professional person in charge of the facility providing evaluation) ․․․․․․․․․․ has appeared before me and appears to be, as a result of ․․․․․․․․․․ (chronic alcoholism, the use of narcotics, or the use of restricted dangerous drugs), a danger to himself, or others, or gravely disabled.

Now, therefore, you are directed to evaluate ․․․․․․․․․․․․ at ․․․․․․․․․․ on the ․․․․․․ day of ․․․․․․․․․․, 19․․․, at ․․․ o'clock ․․․m.

Witness my hand, this ․․․․․․․․․․ day of ․․․․․․․․․․, 19․․․.

I hereby certify that I received the above order for the evaluation of ․․․․․․․․․․ and on the ․․․․․․․․․․ day of ․․․․․․․․․․, 19․․․, personally served a copy of the order and of the petition on the professional person in charge of the ․․․․․․․․․․, a facility for treatment and evaluation, or his designee.

Dated: ․․․․․․․․․․․․․․, 19․․․.