FORM MH-404 Gc Petition for Authority to Consent to Inpatient Mh

• Legal Form Number: FORM MH-404
• Date: 01 January 2022
• Section: AZ MH Forms Annotated

FORM MH-404

(Attorney's name, State Bar No.)

(Attorney's law firm name)

(Law firm bar number)

(Address)

(Phone number)

(Attorney or firm's e-mail address)

Attorney for: __________

SUPERIOR COURT OF ARIZONA, __________ COUNTY

In the Matter of the Guardianship of [and Conservatorship for]: an Adult. NO. __________ PETITION FOR AUTHORITY TO CONSENT TO INPATIENT MENTAL HEALTH CARE AND TREATMENT INCLUDING PLACEMENT

Pursuant to A.R.S. § 14-5312.01(B) and Rule 47(a), Ariz. R. Prob. P., Guardian, __________, states:

1. The Court appointed __________ as guardian on (date).

2. [The current appointment order does not authorize Guardian to consent to inpatient mental health care and treatment including placement in a level one inpatient mental health care and treatment facility.] [Guardian's authority to consent to inpatient mental health care and treatment including placement in a level one inpatient mental health care and treatment facility has expired.]

3. (Subject person's name) is incapacitated as defined by A.R.S. § 14-5101(1) as a result of a mental disorder as defined by A.R.S. § 36-501(25) and is likely to need inpatient mental health care and treatment within the next year. In particular, ____________________.

4. The evaluation by [name of psychiatrist or psychologist] supports this petition and [is filed] [will be filed] as a confidential document.

5. (Subject person's name)...