Form 46-22

NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA

[Caption. The suit must be styled “ex parte” and be in the name of the child.]

Order for Temporary Authorization to Consent to Voluntary Inpatient Mental Health Services for Child

1.Date of Hearing

On [date] the Court heard this case.

2.Appearances

Appearances

3.Jurisdiction

Jurisdiction

The Court, after examining the record and the evidence and argument of counsel, finds that it has jurisdiction of this case and of all the parties and that [no other court has continuing, exclusive jurisdiction of this case/a court order designating conservatorship or guardianship over the child the subject of this suit was entered on [date] in the [designation] Court of [county], [state]].

The Court finds that Petitioner[s] [is/are] eligible to consent to treatment under section 32.001[(a)(1)/(a)(2)/(a)(3)] of the Texas Family Code and that Petitioner[s] [has/have] had actual care, custody, and control of the child for the preceding six months.

All persons entitled to citation were properly cited.

4.Record

Record

4.A.Waived
§ 105.003(c)

The making of a record of testimony was waived by the parties with the consent of the Court.

4.B.Reporter

The record of testimony was duly reported by [[name, address]/the court reporter for the [designation] Court].

5.Child

The Court finds that the following child is the subject of this suit:

Name:

Sex:

Birth date:

Current physical address:

6.Findings

Findings

6.A.Relief Denied

The Court finds that an objection was made to the Petition for Tempo­rary Authorization to Consent to Voluntary Inpatient Mental Health Services for Child by the child’s parent, conservator, or guardian.

The Court finds that the Petition for Temporary Authorization to Con­sent to Voluntary Inpatient Mental Health Services for Child should be denied. IT IS ORDERED that all relief requested in the Petition for Temporary Autho­rization to Consent to Voluntary Inpatient Mental Health Services for Child is DENIED.

The Petition for Temporary Authorization to Consent to Voluntary Inpa­tient Mental Health Services for Child is therefore dismissed.

6.B.Relief Granted

The Court finds that the child the subject of this suit does not have a par­ent, conservator, guardian, or other legal representative available to give con­sent under section 572.001 of the Texas Health and Safety Code and that no objection to this petition was made by the child’s parent, conservator, or guard­ian.

The Court finds by clear and convincing evidence that the child is a per­son with mental illness or who demonstrates symptoms of a serious emotional disorder and who presents a risk of serious harm to self or others if not imme­diately restrained or hospitalized.

IT IS ORDERED that the Petition for Temporary Authorization to Con­sent to Voluntary Inpatient Mental Health Services for Child is GRANTED.

7.Expiration

Expiration

This temporary authorization order expires on the earliest of (1) the date Petitioner[s] request[s] that the child be discharged from the mental health facility; (2) the date a physician determines that the child is no longer a person with mental illness or who demonstrates symptoms of a serious emotional dis­order and who presents a risk of serious harm to self or others if not immedi­ately restrained or hospitalized; or (3) the tenth day after the date this order is issued. However, if Petitioner[s] obtain[s] an order for temporary managing conservatorship before the tenth day after the date this order is issued, this order expires on the earlier of (1) the date Petitioner[s] request[s] that the child be discharged from the mental health facility or (2) the date a physician deter­mines that the child is no longer a person with mental illness or who demon­strates symptoms of a serious emotional disorder and who presents a risk of serious harm to self or others if not immediately restrained or hospitalized.

8.Relief Not Granted

•Required in All Orders

Relief Not Granted

IT IS ORDERED that all relief requested in this case and not expressly granted is denied.

9.Date of Order

Date of Order

SIGNED on ________________________________.

This order judicially PRONOUNCED AND RENDERED in court at [city, county] County, Texas, on [date] and further noted on the court’s docket sheet on the same date, but signed on ___________________________________.

   
JUDGE PRESIDING