Certification of Qualifies Health Professional Involuntary Treatment - courts ky 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the case number and district court information at the top of the form.
3. In the section for the Affiant, provide your name and confirm your status as a Qualified Health Professional by checking the appropriate boxes that apply to your qualifications.
4. Detail your examination findings of the Respondent in the designated fields, including any observations related to alcohol or drug abuse.
5. Provide supporting facts regarding any potential danger posed by the Respondent to themselves or others, ensuring clarity and thoroughness.
6. Complete the diagnostic impressions section, indicating whether the Respondent suffers from substance abuse and their treatment needs.
7. Fill in additional factors contributing to treatment needs and outline goals and recommendations for treatment.
8. Finally, enter the date of examination, sign, and print your name along with your title before submitting.

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