10 GCA § 82A1307: Requirements of Certificate.

The certificate shall be in writing, executed under oath, and shall include the following information:

(a) the name and address, if known, of the respondent;

(b) the name and address, if known, of the respondent’s spouse, legal counsel, conservator or guardian, and next-of-kin;

(c) the name and address, if known, of anyone currently providing psychiatric care to the respondent;

(d) the names and addresses, if known, of other persons with knowledge of the respondent’s mental illness who may be called as witnesses at the assisted treatment hearing;

(e) the name and work address of the certifying psychiatrist or other physician;

(f) the name and address of the facility in which the respondent is undergoing emergency treatment/observation;

(g) the certifying psychiatrist or other physician’s statement that he or she has examined the respondent since the respondent was placed in emergency treatment/observation; and

(h) the certifying psychiatrist or other physician’s statement that, in his or her clinical opinion, the respondent is a danger to himself, herself or to others, or gravely disabled, and the clinical basis for this opinion.