California Code, Welfare and Institutions Code - WIC § 5262

A second notice of certification for imminently suicidal persons is required for all involuntary 14-day intensive treatment, pursuant to this article, and shall be in substantially the following form:

The authorized agency providing 14-day intensive treatment, County of ․․․․․․․․, has custody of:  ․․․․․․․․.

The undersigned allege that the above-named person presents an imminent threat of taking his own life.

This allegation is based upon the following facts:․․․․․․․․․․․․․․․․․

This allegation is supported by the accompanying affidavits signed by ․․․․․․․․.

The above-named person has been informed of this allegation and has been advised of, but has not been able or willing to accept referral to, the following services: ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

facility herein named ․․․․․․․․

We hereby state that a copy of this notice has been delivered this day to the above-named person and that he has been clearly advised of his continuing legal right to a judicial review by habeas corpus, and this term has been explained to him.

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