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WEST VIRGINIA SUPREME COURT OF APPEALS
August 2008 Inventory of Forms * NEW and REVISED Forms for 2008 are indicated below. Destroy old forms in your possession that have been replaced by the NEW or REVISED Forms below. Otherwise, continue use of existing 2007 forms.
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| Form Number |
Description of Form |
Signatory |
|---|---|---|
|
INV 1 901 & 9011 |
Application for Involuntary Custody for Mental Health Examination with Important Information to Applicants [Revised] |
Applicant (under oath) |
|
INV 2 901C |
Application for Incarcerated Individual's Mental Health Examination under WV Code 27-5-2 [Revised] |
Chief Administrative Officer of Correctional Facility (under oath) |
|
INV 3 902 |
Order Denying Application for Involuntary Custody for Mental Health Examination | MHC/Judge/Magistrate |
|
INV 4 903CCF |
Forthwith Order for Examination and Hearing [Revised] | MHC/Judge/Magistrate |
|
INV 5 903CC24 |
24-Hour Order for Examination and
Hearing |
MHC/Judge/Magistrate |
|
INV 6 903M |
Order to Continue/Reschedule Proceedings Due to Respondents Need for Medical Care | MHC/Judge/Magistrate |
|
INV 7 903P |
Order Respondents Request of Up to 48 Hour Postponement | MHC/Judge/Magistrate |
|
INV 8 |
Motion to Withdraw Application for Involuntary Custody for Mental Health Examination [NEW] | Applicant (under oath) |
| INV
9 |
Order Dismissing Proceedings based on Motion of Applicant [NEW] |
MHC/Judge/Magistrate |
| INV
10 904 |
Certificate of Examiner [Revised] | Physician/Psychologist/Ct. Approved Licensed Clinical Social Worker/Ct. Approved Advanced Nurse Practitioner/Physician Assistant |
| INV
11 905NC |
Order of Dismissal and Release of Respondent Based on Examination by Physician/Psychologist (Prior to Probable Cause Hearing) | MHC/Judge/Magistrate |
| INV
12 905 |
Order of No Probable Cause | MHC/Judge/Magistrate |
| INV
13 906R & 906NR |
Probable Cause Order for Involuntary Hospitalization
[Revised] (Resident & Non-resident combined) |
MHC/Judge/Magistrate |
| INV
14 907B |
Voluntary Treatment Agreement (VTA) | Respondent + Counsel for Resp. + MHC/Judge/Magistrate |
| INV
15 907 |
§ 27- 5- 4 Order for Release
VTA (Probable Cause) [Revised] |
MHC/Judge/Magistrate |
| INV
16 907C |
Motion for Hospitalization Due to Noncompliance with VTA | Men. Hlth. Cntr. or Other Movant |
| INV
17 907D |
Forthwith Order for Detention &
Hearing on Motion for Hospitalization Due to Noncompliance [Revised] |
MHC/Judge/Magistrate |
| INV
18 907E |
24-Hour Order for Detention & Hearing on Motion for Hospitalization Due to Noncompliance | MHC/Judge/Magistrate |
| INV
19 907F |
Order for Involuntary Hospitalization (§ 27- 5-3) Due to Noncompliance with VTA [Revised] | MHC/Judge/Magistrate |
| INV
20 907G |
Order for Dismissal of Motion to
Hospitalize Due to Noncompliance with VTA |
MHC/Judge/Magistrate |
| INV
21 907H |
Motion for Cancellation or
Modification of VTA |
Respondent |
| INV
22 907I |
Order for Hearing & Notice
on Motion to Cancel or Modify |
MHC/Judge/Magistrate |
| INV
23 907J |
Order which Either Grants or Denies Motion to Cancel or Modify | MHC/Judge/Magistrate |
| INV
24 907A |
§ 27-
5-4 Order for Release via VTA (Final Commitment) [Revised] |
MHC/Judge |
| INV 25 | Order Dismissing Proceedings based upon Expiration of Statutory Time Limit [NEW] | MHC/Judge/Magistrate |
| INV
26 907K |
Chief
Medical Officer's Application for Final Commitment [Revised] |
Chief Medical Officer |
| INV
27 908 |
Order Denying Application for Final Commitment | MHC/Judge |
| INV
28 909 |
Order Granting Application for Final Commitment | MHC/Judge |
| INV
29 911 |
Notice of Final Commitment Hearing | Circuit Clerk |
| INV
30 914 |
Dismissal of Final Commitment Proceedings Based on Report of Physician or Psychologist | MHC/Judge |
| INV
31 915 |
Dismissal of Final Commitment Proceedings - all other grounds | MHC/Judge |
| INV
33 917 |
Order Granting Final Commitment - WV
Resident [Revised] |
MHC + Judge |
| INV
34 917(o) |
Order of Commitment to Responsible
Person [Revised] |
MHC + Judge |
| INV
35 917(p) |
Order Granting Final Commitment - Non WV Resident [Revised] | MHC + Judge |
| INV
36 917(n)(1) |
Order Certifying Transcript & Finding of Final Commitment for Resident of Another County | MHC/Judge |
| INV
37 917(n)(2) |
Order Confirming Final Commitment Held in Another County | MHC + Judge |
| INV
38 920 |
§ 27-7-4 Order of Return to Mental Health Facility for Patient Released Under § 27-7-2 or 3 | Judge |
| INV
39 920CMO |
Order to Return Escaped Patient to Facility | Chief Medical Officer of Mental Health Facility |
|
INV 40 921 |
Report of Discharge of Patient | Chief Medical Officer of Mental Health Facility |
|
Exam 1 923 |
Petition for Court Authorization to Perform Examinations for Probable Cause Proceedings for Involuntary Hospitalization [Revised] | Licensed In dependent Clinical Social Worker or Advanced Nurse Practitioner with Psychiatric Certification |
|
Exam 2 924 |
Order: Of Authorization to Perform Examinations [Revised] | Judge |
|
Exam 3 924D |
Order: Denying Authorization to Perform Examinations [Revised] |
Judge |
|
Exam 4 924R |
Report/Request of Court Authorized Examiner Regarding Licensing Change [Revised] | Licensed Independent Clinical Social Worker or Advanced Nurse Practitioner with Psychiatric Certification |
| INV
41 925 |
Order for Payment of Mental Hygiene Commissioner | Judge |
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