Cal. Welfare and Institutions Code § 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: To the Superior Court of the State of California for the County of ______ The authorized agency providing 14-day intensive treatment, County of _________, has custody of: _________ Name ____________ Address ____________ Age ____________ Sex ____________ Marital status ____________ Religious affiliation ____________ 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: We, therefore, certify the above-named person to receive additional intensive treatment for no more than 14 days beginning this day of (Month) , 19__, in the intensive treatment 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. (Date) Signed Countersigned Representing intensive treatment facility