DHCS 1801 Application for up to 72-Hour Assessment ...
Application is hereby made for the assessment and evaluation of , date of irth of , and residing at , California, for o 72- hour assessment, evaluation, and crisis intervention, or placement for evaluation and treatment at a designated facility pursuant to Section 5150, et seq. (adult) or Section 5585 et seq. (minor), of he W&I Code. ................
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