Welf. & Inst. Code, § 5227

The order for evaluation shall be in substantially the following form:

In the Superior Court of the State of California for the County of _____

______ The People of the State of California Concerning ______ and ______Respondents______ No. _____ Order for Evaluation

______

The People of the State of California to ______

______ :

(Professional person in charge of the facility providing evaluation)

______ has appeared before me and appears to be, as a result of ______ (chronic alcoholism, the use of narcotics, or the use of restricted dangerous drugs), a danger to himself, or others, or gravely disabled. Now, therefore, you are directed to evaluate ______ at ______ on the ____ day of ____, 19__, at __ o’clock _m. Witness my hand, this ____ day of ____, 19__.

____________Judge of the ________ Court______

Return of Order

I hereby certify that I received the above order for the evaluation of ______ and on the ____ day of ____, 19__, personally served a copy of the order and of the petition on the professional person in charge of the ______, a facility for treatment and evaluation, or his designee.

Dated: ____ 19__.

____________Signature and Title______