California Code, Welfare and Institutions Code - WIC § 6252

Wherever provision is made in this code for a judge of a superior court to issue and deliver an order for examination or detention directing that a person be apprehended and taken before a judge of a superior court for a hearing and examination on an allegation of being a person subject to judicial commitment, the order for examination or detention shall be in substantially the following form:

The People of the State of California ․․․․․․․․․․․․․․․․․․․․

The petition for ․․․․․․․․ having been presented this day to me, a Judge of the Superior Court in and for the County of ․․․․․․․․, State of California, from which it appears that there is now in this county, at ․․․․․․․․, a person by the name of ․․․․․․․․, who is a ․․․․․․․․.

And it satisfactorily appears to me that said person is sufficiently ․․․․․․․․ that examination should be made and hearing held, if demanded, to determine the supervision, treatment, care or restraint, if any, necessary for his best interest and protection, and the protection of the people.

I do hereby appoint ․․․․․․․․ and ․․․․․․․․ as medical examiners to make a personal examination of ․․․․․․․․, the person alleged to be ․․․․․․․․, and to report thereon to the court, pursuant to Section ․․․․․․․․ of the Welfare and Institutions Code.

* Now, therefore, you are commanded to notify said ․․․․․․․․, to submit to an examination ․․․․․․․․ on or before the ․․․․ day of ․․․․․․․․, that thereafter he may be taken before a judge of the superior court in this county for examination and hearing to determine the measures to be taken for the best interest and protection of said ․․․․․․․․, as a ․․․․․․․․, as provided by law.

* And it affirmatively appearing to me that said person is sufficiently ․․․․․․․․ that he is likely to injure himself or others if not immediately hospitalized or detained, you are therefore commanded to forthwith detain said ․․․․․․․․, or cause him to be detained for examination and hearing, pending the further order of the judge, at ․․․․․․․․, and there be cared for in a humane manner as a ․․․․․․․․ and provided with any medical treatment deemed necessary to his physical well-being.

* And it satisfactorily appearing to me that said person has failed or has refused to appear for examination when notified by order of this court, you are therefore commanded to forthwith detain said ․․․․․․․․ or cause him to be detained for examination and hearing, pending the further order of the judge, at ․․․․․․․․, and there be cared for in a humane manner as a ․․․․․․․․.

I hereby direct that a copy of this order, together with a copy of the said petition be delivered to said person and his representative, if any, at the time of his notification; and I further direct that this order may be served at any hour of the night.

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

* Strike out when not applicable.

I hereby certify that I received the above order for examination or detention, and on the ․․․․․․․․ day of ․․․․․․․․, 19․․․․, served it by notifying and delivering to said ․․․․․․․․ personally, and to his representatives, if any, to wit, ․․․․․․․․, a copy of the order and of the petition,* or by apprehending said person and causing h․․ to be detained for examination and hearing and for humane care as an alleged ․․․․․․․․ at ․․․․․․․․; until further ordered and directed by the judge.

* I hereby certify that prior to the service of the above order for detention and the apprehension of ․․․․․․․․ I served notice on the person and his representative, if any, as required under Article 2 (commencing with Section 5200) of Chapter 2 of Part 1 of Division 5 of the Welfare and Institutions Code.

Dated ․․․․․․․․, 19․․․․.

* Strike out when not applicable.