First Judicial District of PennsylvaniaCourt of Common Pleas 225 Philadelphia CountyMental Health Procedures Act Cover Sheet Docket NumberFOR OFFICIAL USE ONLY In Re:LAST NAMESS #HOME ADDRESSDATE OF BIRTH FIRST NAME PRIOR CASE I.D. NO. ALIASGENDER Male Female Current Commitment Under Section Expires on at AM/PM.Requested Hearing Date: Time: Location: PETITIONER FACILITYTYPE OF FILING 303 306 304(b) 406 304(c) Petition for Review 305 ADDRESSOrderAND NOW, this day of , 20 , upon consideration of the attachedApplication or Petition, an Informal Conference or Hearing shall be held by a Mental Health Review Officer or Judgepursuant to Phila. R. Civ. P. No. 7109 on the day of , 20 at AM/PM at the following location: Albert Einstein Medical Center Norristown State Hospital Girard Medical Center Philadelphia Detention Center Friends Hospital The Defender Association of Philadelphia is appointed to represent the patient-respondent. FOR THE COURT: President JudgeBy: Pro Prothy 01-108 (Rev. ) NAME OF PETITIONER222S ATTORNEY ADDRESSPHONE City Solicitor of PhiladelphiaOne Parkway Center1515 Arch Street, 16th FloorPhiladelphia, PA 19102215-683-5100SUPREME COURT I.D. NO. NAME OF PERSON/PATIENT/RESPONDENT222S ATTORNEY ADDRESSPHONE Defender Association of Philadelphia1441 Sansom StreetPhiladelphia, PA 19102-3004215-765-6500SUPREME COURT I.D. NO. COUNSEL American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS1)As required by Philadelphia Civil Rule No. 7109.1, Applications and Petitions must beelectronically filed with the Office of Judicial Records through the Court222s website,http://www.courts.phila.gov (On-Line Services Tab, 223Civil Mental Health224 link). 2)The Petitioner must attach a copy of the 302 Application when filing a 303 Application.Failure to attach the 302 Application may result in dismissal of the 303 Petition. 3)After the Application or Petition is reviewed and accepted for filing by the Office of JudicialRecords, the conference or hearing will be scheduled as requested by the Petitioner. ThePetitioner, the Petitioning Facility, the Defender Association and the City Solicitor will benotified, via email, that the legal paper was filed and that a conference or hearing wasscheduled through the Civil Mental Health Electronic Filing System. The Petition, 302 andcompleted Cover Sheet is available online. See Philadelphia Civil Rule No. 7109.1 (4).4)The 303 Application must be filed by 11:00 AM the day before the requested hearing date. A copy of any Application filed after that Date/Time must be emailed by the Petitioner (together with the 302 Application) to the City Solicitor222s Office, the Defender Association,and, for cases heard at Friends, to court-appointed counsel.5)The conference or hearing will be scheduled as follows:a.within 24 hours after the filing of an Application pursuant to Section 303 of the Act;provided, however, that Applications filed after court-hours on Fridays will be scheduledfor the next business day;b.within five (5) days after the filing of a Petition pursuant to Sections 304 and 305 of theAct;c.within three (3) days after a Petition for Review is filed, consistent with the hearingjudge222s schedule; andd.as requested by the Petitioner in Intellectual Disability cases, pursuant to (Section 406) ofthe MHMRA of 1966.6)Any orders issued by the MHRO are available through the Mental Health site.7)Petitions for Review must be filed by counsel through the Mental Health site, and a hearingdate will be scheduled, within three days, as soon the hearing has been transcribed.LocationofMentalHealthHearingSitesAlbert Einstein Medical Center Norristown State Hospital 5583 Park Avenue 1001 Stergiere, Bldg. 10 & 52 Philadelphia Detention Center 8201 State Road Philadelphia, PA 19141 Norristown, Pa 19406 Philadelphia, PA 19136 Phone (215) 456-7095 Phone: (610) 313-5357 Phone: (215) 685-8580 Fax: (215) 456-6453 Fax: (610) 313-5666 Girard Medical Center Friends Hospital Petitions for Review 8th Street and Girard Avenue 4641 Roosevelt Boulevard Heard at City Hall Philadelphia, PA 19122 Philadelphia, PA 19124 Room Number To Be Assigned Phone: (215) 787-6998 Phone: (215) 831-4703 Philadelphia, PA 19107 Fax: (215) 787-6986 Fax: (215) 831-3565 Please Note: The Information Contained Herein May Change Without Notice (5-01-18) American LegalNet, Inc. www.FormsWorkFlow.com Notice of Language Rights Language Access Coordinator Land Title Building, 100 South Broad Street, Second Floor, Philadelphia, PA 19110 215-683-8000; languageaccesscoordinator@courts.phila.gov English: You have the right to an interpreter at no cost to you. 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