Form AOC-700A "Verified Petition for 60/360 Day Involuntary Treatment (Substance Use Disorder)" - Kentucky

What Is Form AOC-700A?

This is a legal form that was released by the Kentucky Court of Justice - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Kentucky Court of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AOC-700A by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

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Download Form AOC-700A "Verified Petition for 60/360 Day Involuntary Treatment (Substance Use Disorder)" - Kentucky

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AOC-700A
Doc. Code: PIHAD
Case No. ____________________
Rev. 6-19
Page 1 of 3
l e x
Court ________________________
District
e t
j u s t i t i a
Commonwealth of Kentucky
County ______________________
Court of Justice
www.courts.ky.gov
Verified Petition
For 60/360 Day Involuntary Treatment
Division ______________________
KRS 222.432
(Substance Use Disorder)
IN THE INTEREST OF: ____________________________________________________________________
Respondent's Name (please print)
RESPONDENT'S RESIDENCE ADDRESS: (please print)
______________________________________________________________________________________
______________________________________________________________________________________
Phone Number: _________________________________
CURRENT LOCATION: (if different)
______________________________________________________________________________________
______________________________________________________________________________________
Phone Number: _________________________________
1.
PETITIONER, ______________________________________________________________________
Petitioner's Name (please print)
PETITIONER'S ADDRESS:
(please print)
___________________________________________________________________________________
___________________________________________________________________________________
Phone Number: _________________________________
states that he/she is: q Spouse; q Relative; q Friend; or q Guardian, of the above-named Respondent.
2.
PETITIONER further states that the name, address, and residence of persons related to the Respondent are:
(if unknown, so state)
Parents or guardian: ___________________________________________________________________________
Spouse: _____________________________________________________________________________________
Person having custody of Respondent: _____________________________________________________________
Near relative: _________________________________________________________________________________
Other: ______________________________________________________________________________________
3.
PETITIONER believes that the Respondent is a person suffering from a substance use disorder because:
(state facts to support belief)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
AOC-700A
Doc. Code: PIHAD
Case No. ____________________
Rev. 6-19
Page 1 of 3
l e x
Court ________________________
District
e t
j u s t i t i a
Commonwealth of Kentucky
County ______________________
Court of Justice
www.courts.ky.gov
Verified Petition
For 60/360 Day Involuntary Treatment
Division ______________________
KRS 222.432
(Substance Use Disorder)
IN THE INTEREST OF: ____________________________________________________________________
Respondent's Name (please print)
RESPONDENT'S RESIDENCE ADDRESS: (please print)
______________________________________________________________________________________
______________________________________________________________________________________
Phone Number: _________________________________
CURRENT LOCATION: (if different)
______________________________________________________________________________________
______________________________________________________________________________________
Phone Number: _________________________________
1.
PETITIONER, ______________________________________________________________________
Petitioner's Name (please print)
PETITIONER'S ADDRESS:
(please print)
___________________________________________________________________________________
___________________________________________________________________________________
Phone Number: _________________________________
states that he/she is: q Spouse; q Relative; q Friend; or q Guardian, of the above-named Respondent.
2.
PETITIONER further states that the name, address, and residence of persons related to the Respondent are:
(if unknown, so state)
Parents or guardian: ___________________________________________________________________________
Spouse: _____________________________________________________________________________________
Person having custody of Respondent: _____________________________________________________________
Near relative: _________________________________________________________________________________
Other: ______________________________________________________________________________________
3.
PETITIONER believes that the Respondent is a person suffering from a substance use disorder because:
(state facts to support belief)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
AOC-700A
Rev. 6-19
Page 2 of 3
4. PETITIONER also believes that the Respondent presents a danger or threat of danger to self, family or others
because: (state facts to support belief)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
5. PETITIONER requests that the Respondent be detained for examination, evaluation and hospitalization/admittance
to a treatment facility if he/she meets the criteria for:
q involuntary treatment for not more than sixty (60) consecutive days; or
q involuntary treatment for not more than three hundred and sixty (360) consecutive days.
_____________________________, 2______
____________________________________________
Date
Signature of Petitioner
____________________________________________
Name of Petitioner (please print)
SUBSCRIBED AND SWORN TO before me this ________ day of __________________________, 2________
My Commission Expires: _________________________
____________________________________________
Notary/Clerk
By: ____________________________________, D.C.
The Petitioner or other authorized person (spouse, relative, friend, or guardian) must guarantee all cost for treatment.
Page 3, "Guarantee of Payment," must be completed and notarized.
AOC-700A
Rev. 6-19
Page 3 of 3
GUARANTEE OF PAYMENT
Pursuant to KRS 222.432(4)(f), either the Petitioner or other authorized person (spouse, relative, friend, or
guardian) shall guarantee any and all costs for treatment of the Respondent for a substance use disorder, as may
be hereinafter ordered by the Court. The GUARANTEE below shall be completed by either the Petitioner or other
authorized person.
By my signature below, I do hereby assume responsibility for and GUARANTEE PAYMENT FOR ALL COSTS
incurred on behalf of the Respondent for all substance use disorder treatment, including, but not limited to, initial
examination and transportation costs, as hereinafter ordered by the Court.
_____________________________, 2______
____________________________________________
Date
Name (please print)
____________________________________________
____________________________________________
Relationship to Respondent
Signature
(Petitioner, or Spouse, Relative, Friend, Guardian)
Billing Address: ____________________________________________
____________________________________________
____________________________________________
SUBSCRIBED AND SWORN TO before me this ________ day of __________________________, 2________
My Commission Expires: _________________________
____________________________________________
Notary/Clerk
By: _____________________________________, D.C.
Attach copy of Verified Petition to each copy of Warrant, Summons, and Hearing, Examination and
Appointment of Counsel Notice and Order.
Distribution:
Respondent; Petitioner; Respondent's Legal Guardian, Spouse, Parent(s), Near Relative or Friend
(if applicable).
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