Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT __________________ In the Matter of the Necessity for the Hospitalization of: , Respondent. ) ) ) ) ) )

Case No. NOTICE OF RIGHTS UPON DETENTION FOR EVALUATION

TO:____________________________________ You are entitled to a court hearing within 72 hours of your arrival at this facility. The hearing will determine whether there is cause to detain you after the 72 hours have expired for up to an additional 30 days on the grounds that you are mentally ill and as a result of that condition are gravely disabled or are likely to cause serious harm to yourself or others. You have the right to communicate immediately (at the state's expense) with your guardian, if any, or an adult designated by you. You may also communicate with the attorney designated by the court or an attorney of your choice. You have the right to be represented by an attorney, to present evidence and to crossexamine witnesses who testify against you at the hearing. You have the right to be free of the effects of medication and other forms of treatment to the maximum extent possible before the 30-day commitment hearing. I certify that on ___________________, 20___, at _____ ___.m., I verbally advised the respondent of his/her rights under AS 47.30.725 and delivered a copy of this document to the respondent.

Date

Signature Print Name and Title

Distribution: Original to court Copy to respondent Copy to evaluation facility The respondent's guardian, if any, and if the respondent requests, an adult designated by the respondent, shall also be notified of the respondent's rights explained on this notice.

MC-405 (3/01)(st.3) NOTICE OF RIGHTS UPON DETENTION FOR EVALUATION

AS 47.30.725