Mental Health Procedures Act Cover Sheet Form. This is a Pennsylvania form and can be use in Philadelphia Local County.
Tags: Mental Health Procedures Act Cover Sheet, 01-108, Pennsylvania Local County, Philadelphia
First Judicial District of Pennsylvania Court of Common Pleas • Philadelphia County Mental Health Procedures Act Cover Sheet In Re: LAST NAME FIRST NAME Docket Number ALIAS DATE OF BIRTH SS # FOR OFFICIAL USE ONLY GENDER Male Female PRIOR CASE I.D. NO. HOME ADDRESS PETITIONER Current Commitment Under Section FACILITY Expires on at AM/PM. ADDRESS Requested Hearing Date: TYPE OF FILING 303 304(b) 304(c) 305 306 406 Petition for Review Time: Location: Order AND NOW, this day of , 20 , upon consideration of the attached Application or Petition, an Informal Conference or Hearing shall be held by a Mental Health Review Officer or Judge day of , 20 at AM/ pursuant to Phila. R. Civ. P. No. 7109 on the 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: Pamela Pryor Dembe President Judge By: Pro Prothy COUNSEL NAME OF PETITIONER’S ATTORNEY NAME OF PERSON/PATIENT/RESPONDENT’S ATTORNEY City Solicitor of Philadelphia ADDRESS Defender Association of Philadelphia ADDRESS One Parkway Center 1515 Arch Street, 16th Floor Philadelphia, PA 19102 PHONE SUPREME COURT I.D. NO. 215-683-5100 01-108 (Rev. 7/09) 1441 Sansom Street Philadelphia, PA 19102-3004 PHONE SUPREME COURT I.D. NO. 215-765-6500 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. Applications or Petitions must be electronically filed with the Prothonotary as required by Philadelphia Civil Rule No. 7109.1 through the FJD Website, http://courts.phila.gov, On-Line Services Tab, “CP Mental Health System” link. 2. The Petitioner must attach a copy of the 302 Application when filing a 303 Application. 3. The Prothonotary will schedule a conference or hearing after the legal paper is reviewed and accepted for filing. As provided by Philadelphia Civil Rule No. 7109.1 (4), the Prothonotary shall notify all parties that the legal paper was filed, and that a conference or hearing scheduled, through the Civil Mental Health Electronic Filing System. 4. A 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 on Friday after court-hours will be scheduled for the next business day; b. within five (5) days after the filing of a Petition pursuant to Sections 304 and 305 of the Act; c. within three (3) days after a Petition for Review is filed, consistent with the hearing judge’s schedule; and d. as requested by the Petitioner in Mental Retardation cases. Location of Mental Health Hearing Sites Albert Einstein Medical Center 5583 Park Avenue Philadelphia, PA 19141 Phone (215) 456-7095 Fax: (215) 456-6453 Norristown State Hospital 1001 Stergiere, Bldg. 10 & 52 Norristown, Pa 19406 Phone: (610) 313-5357 Fax: (610) 313-5666 Girard Medical Center 8th Street and Girard Avenue Philadelphia, PA 19122 Phone: (215) 787-6998 Fax: (215) 787-6986 Friends Hospital 4641 Roosevelt Boulevard Philadelphia, PA 19124 Phone: (215) 831-4703 Fax: (215) 831-3565 Please Note: The Information Contained Herein May Change Without Notice (July 2009) American LegalNet, Inc. www.FormsWorkFlow.com