N.M. R. Child. Ct. 10-601
[For use with Section 32A-6A-20 NMSA 1978]
STATE OF NEW MEXICO
COUNTY OF _______________
__________________ JUDICIAL DISTRICT
IN THE CHILDREN'S COURT
STATE OF NEW MEXICO ex rel.
CHILDREN, YOUTH AND FAMILIES DEPARTMENT
No. __________
IN THE MATTER OF
_______________________________
VOLUNTARY CONSENT TO
VOLUNTARY ADMISSION FOR
[RESIDENT IAL TREATMENT] [HABILITATION]
___________________________ (name of guardian or legal custodian) states that I am the parent, guardian, or legal custodian of __________________ , a child under the age of fourteen (14) years, and that, pursuant to Section 32A-6A-20 NMSA 1978:
(check applicable)
___ 1. I am voluntarily admitting my child to ____________________ (place admitted).
___ 2. I have been advised and understand that I have the right to voluntarily consent or refuse to consent to my child's admission for treatment.
___ 3. I agree to my child participating in treatment programs based on my child's individual needs as may be deemed appropriate by the treatment team.
___ 4. I understand that I have the right to request an immediate discharge of my child from the treatment program at any time.
___ 5. I understand that if I should request a discharge of my child and my child's physician, licensed psychologist, or director of the residential treatment program determines that my child needs continued treatment, that on the first business day following my request for discharge, the children's court attorney or district attorney may begin involuntary commitment proceedings.
___ 6. I understand that if involuntary commitment proceedings are filed, my child has a right to a court hearing on continued treatment within seven (7) days after my request that my child be discharged.
___ 7. My rights have been explained to me in the language of my preference, which is ________________ (specify language).
________________________________
(Parent) (guardian) (legal custodian)
________________________________
Date
WITNESS
I state that I have witnessed the signature of the above parent, guardian, or legal custodian and that I explained the contents of each of the numbered paragraphs to the parent, guardian, or legal custodian and to the minor child and I believe that they understand clearly the contents of those paragraphs.
________________________________
Witness
________________________________
Date
[Approved, effective July 1, 2002; 10-491 recompiled and amended as 10-601 by Supreme Court Order No. 14-8300-009, effective for all cases filed or pending on or after December 31, 2014.]
N.M. R. Child. Ct. 10-601
ANNOTATIONS The 2014 amendment, approved by Supreme Court Order No. 14-8300-009, effective December 31, 2014, changed the statutory reference from the repealed statute to the current consent to placement statute; in the "For use with" note and first paragraph, changed "32A-6-11.1(C)" to "32A-6A-20". Recompilations. - Pursuant to Supreme Court Order No. 14-8300-009, former Form 10-491 NMRA was recompiled and amended as Form NMRA, effective December 31, 2014.