Juveniles aged 13 and older shall be given the following notice:
RIGHTS OF CHILDREN UNDER
SECTIONS 402 AND 403 OF THE MENTAL HEALTH
AND INTELLECTUAL DISABILITY ACT OF 1966
You have currently been admitted to the ______________________________________ Institution for observation and treatment. This voluntary admission procedure was instituted by ______________________________________ or _________________________ (date). You can call the applicant at Telephone Number ____________ or you can write the applicant at _________________________ . The purpose in having you admitted to this facility is to help you overcome problems you are experiencing and to return you to the community as soon as possible. Before we accepted you, you must realize that a (circle which one) psychiatric, medical, or psychological opinion was given to us by _________________________ . Also, the Director of this Institution had a (circle which one) psychiatric, medical, or psychological examination conducted so that he could be thoroughly apprised and certain that you could benefit in receiving care and treatment at this Institution.
If you object to remaining in this Institution, you are advised that we shall contact the Public Defender's Office or make other suitable arrangements to obtain legal counsel for you. We will provide you with the telephone number of the attorney who has been contact on your behalf. We will require 2 working days from date of your objection to remain, in order to make certain that you will be afforded counsel. At the same time, the Director, or his delegate, of this Institution shall notify the applicant of his desire to require your hospitalization for your benefit.
A member of our staff shall explain this written letter to you and we ask you to sign it, which will evidence that you have a copy of this letter and that it has been explained to you in detail. In the event that you have any questions, you can direct them to the person who is explaining this document to you or you may contact this office. ______________________________________
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Superintendent's Signature
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Resident's Signature
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Staff Member Signature
Giving Notice Resident
55 Pa. Code § 6250.22
The provisions of this § 6250.22 amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4201(2) and (8) and 4202).