Free Petition For Commitment - Massachusetts


File Size: 161.2 kB
Pages: 1
Date: January 12, 2007
File Format: PDF
State: Massachusetts
Category: Court Forms - State
Author: Administrative Office of the District Court Department
Word Count: 811 Words, 5,085 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.mass.gov/courts/courtsandjudges/courts/districtcourt/petition_for_commitment.pdf

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Preview Petition For Commitment
PETITION FOR COMMITMENT
OF ALCOHOLIC OR SUBSTANCE ABUSER G.L. c. 123, 35 IN THE MATTER OF

DOCKET NO. DIVISION

Trial Court of Massachusetts District Court Department
DOB OR AGE GENDER

NAME OF RESPONDENT

MALE

FEMALE

PETITION FOR COMMITMENT
of Alcoholic or Substance Abuser G.L. c. 123 35
The undersigned petitioner hereby applies to this court for an order committing the respondent named above for inpatient care and treatment for alcoholism and/or substance abuse for a period not to exceed 30 days under the provisions of G.L. c. 123, 35. The petitioner has reason to believe that there is a likelihood of serious harm as a result of the respondent's chronically or habitually consuming or ingesting alcoholic beverages and/or controlled substances to the extent that such use substantially injures the respondent's health or substantially interferes with the respondent's social or economic functioning, or that the respondent has lost the power of self-control over the use of such beverages and/or substances
DATE SIGNED PETITIONER'S PRINTED NAME

x

PETITIONER'S SIGNATURE PETITIONER'S TITLE OR RELATIONSHIP, IF ANY, TO RESPONDENT

EXCERPTS FROM G.L. c. 123, 1 and 35
G.L. c. 123, 1. Definitions. '''Likelihood of serious harm', (1) a substantial risk of physical harm to the person himself as manifested by evidence of, threats of, or attempts at, suicide or serious bodily harm; (2) a substantial risk of physical harm to other persons as manifested by evidence of homicidal or other violent behavior or evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them; or (3) a very substantial risk of physical impairment or injury to the person himself as manifested by evidence that such person's judgment is so affected that he is unable to protect himself in the community and that reasonable provision for his protection is not available in the community." G.L. c. 123, 35. Commitment of alcoholics or substance abusers. "For the purposes of this section, 'alcoholic' shall mean a person who chronically or habitually consumes alcoholic beverages to the extent that (1) such use substantially injures his health or substantially interferes with his social or economic functioning, or (2) he has lost the power of self-control over the use of such beverages. "For the purposes of this section, 'substance abuser' shall mean a person who chronically or habitually consumes or ingests controlled substances to the extent that (1) such use substantially injures his health or substantially interferes with his social or economic functioning, or (2) he has lost the power of self-control over the use of such controlled substances. "Any police officer, physician, spouse, blood relative, guardian or court official may petition in writing any district court . . . for an order of commitment of a person whom he has reason to believe is an alcoholic or substance abuser . . . . [T]he court shall immediately schedule a hearing on the petition and shall cause a summons and a copy of the application to be served upon the person . . . . [I]f there are reasonable grounds to believe that such person will not appear and that any further delay in the proceedings would present an immediate danger to the physical well-being of the respondent, said court may issue a warrant for the apprehension and appearance of such person before it. No arrest shall be made on such warrant unless the person may be presented immediately before a judge of the district court . . . . The court shall order examination by a qualified physician or a qualified psychologist. "If, after a hearing, the court based upon competent medical testimony finds that said person is an alcoholic or substance abuser and there is a likelihood of serious harm as a result of his alcoholism or substance abuse, it may order such person to be committed for a period not to exceed thirty days. Such commitment shall be for the purpose of inpatient care in public or private facilities approved by the department of public health . . . for the care and treatment of alcoholism or substance abuse. The person may be committed to the Massachusetts correctional institution at Bridgewater, if a male, or at Framingham, if a female, provided that there are not suitable facilities available . . . ; and provided, further, that the person so committed shall be housed and treated separately from convicted criminals. A person so committed may be released prior to the expiration of the period of commitment upon determination by the superintendent that release of said person will not result in a likelihood of serious harm. Said person shall be encouraged to consent to further treatment and shall be allowed voluntarily to remain in the facility for such purposes. "Nothing in this section shall preclude any public or private facility for the care and treatment of alcoholism or substance abuse . . . . from treating persons on a voluntary basis."

http://trialcourtweb.jud.state.ma.us/courtsandjudges/courts/districtcourt/formsfordownload.html (Rev. 11/06)