Free 01-108 Mental Health Cover Sheet.pmd - Pennsylvania

In Re:
LAST NAME ALIAS

Mental Health Procedures Act Cover Sheet
FIRST NAME

First Judicial District of Pennsylvania Court of Common Pleas · Philadelphia County

Docket Number

SS #

DATE OF BIRTH

GENDER

FOR OFFICIAL USE ONLY
Female
PRIOR CASE I.D. NO.

Male
HOME ADDRESS

PETITIONER

Current Commitment Under Section
FACILITY

Expires on AM/PM. Requested Hearing Date: Time: Location:

at

ADDRESS

TYPE OF FILING

303 304(b) 304(c) 305

306 406 Petition for Review

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 ADDRESS

Defender Association of Philadelphia

One Parkway Center 1515 Arch Street, 16th Floor Philadelphia, PA 19102
PHONE SUPREME COURT I.D. NO. PHONE

1441 Sansom Street Philadelphia, PA 19102-3004
SUPREME COURT I.D. NO.

215-683-5100
01-108 (Rev. 7/09)

215-765-6500

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 Girard Medical Center 8th Street and Girard Avenue Philadelphia, PA 19122 Phone: (215) 787-6998 Fax: (215) 787-6986 Norristown State Hospital 1001 Stergiere, Bldg. 10 & 52 Norristown, Pa 19406 Phone: (610) 313-5357 Fax: (610) 313-5666 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)