JV-223 Order Regarding Application for Psychotropic Medication
JV-223, Page 1 of 1
Judicial Council of California, www.courtinfo.ca.gov
New January 1, 2008, Mandatory Form
Welfare and Institution Code, § 369.5
California Rules of Court, rule 5.640
Date:
This order is effective until terminated or modified by court order or until 180 days from the date of this
order, whichever is earlier. If the prescribing physician i s no longe r tr eating the child, this order extends to
subsequent treating physicians. A change in the child’s placement does not require a new order regarding
psychotropic medication. Except in an emergency situation, a new application must be submitted and
consent granted by the court before giving the child medication not authorized in this order or increasing
medication dosage beyond the maximum daily dosage authorized in this order.
Order Regarding Application for
Psychotropic Medication
.
The Court read and considered:
The Court finds and orders:
at (time):
The matter is set for hearing on (date):
in (dept.):
1
2
Notice requirements were met.
Notice requir ements were not met. Proper notice was not given to:
a.
b
.
Signature of judge or judicial officer
3
granted as requested.
a.
denied (specify reason for denial):
c.
15
granted with the following modification or conditions to the request as made in
b.
on the attached
page 3 of JV-220(A) (specify all modifications and conditions):
15
Application was made for authorization to begin or to continue giving
The application is (check one):
the child the psychotropic medication listed in
on page 3 of
A copy of page 3 is attached to this order.
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Case Number:
Fill in case number when form is filed.
Child's Name:
Fill in child's name and date of birth:
JV-223
Order Regarding Application for
Psychotropic Medication
a.
JV-220, Application Regarding Psychotropic Medication, and JV-220(A),
b.
c.
JV-222, Opposition to Application Regardin g Psychotropic
Other (specify):
Prescribing Physician's Statement—Attachment, filed on (date):
Medication, filed on (date):
4
Other (specify):
Date of Birth:
JV-220(A).
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