Form 10-602. Guardian ad litem certification of [continued] [admission] [placement] for [residential treatment] [habilitation].

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 _______________________________ GUARDIAN AD LITEM CERTIFICATION OF [CONTINUED] [ADMISSION] [PLACEMENT] FOR [RESIDENTIAL TREATMENT] [HABILITATION]1 ___________________________, guardian ad litem for the above child, certifies pursuant to Section 32A-6A-20 NMSA 1978 the following: 1. __________________ (initials and date of birth of child) was admitted to ____________________ (place admitted) on ___________________ (date). 2. The child was advised of the child’s rights on ___________ (date). 3. Pursuant to Section 32A-6A-20 NMSA 1978, I certify that I have met with the child, the child’s legal custodian, and the child’s clinician and that I have determined the following: (provide a detailed factual explanation for each) a. On ______________ (date), I met with the child’s parent, guardian, or legal custodian, ______________ (name), who [does] [does not] understand and [does] [does not] consent to the child’s admission to a [residential treatment] [habilitation] program.2 b. The admission [is] [is not] in the child’s best interests because ______________________________________________________________________ _____________________________________________________________________. c. The admission [is] [is not] appropriate for the child because ______________________________________________________________________ _____________________________________________________________________. d. The admission [is] [is not] consistent with the least restrictive means principle because ______________________________________________________________________ _____________________________________________________________________. e. The child’s clinician [does] [does not] recommend [continued] admission because _____________________________________________________________________ _____________________________________________________________________. 4. Based on the above determination, I recommend the following: (choose only one option) [ ] a. The child should [continue to] be admitted to a [residential treatment] [habilitation] program because all of the requirements in Paragraph Three (3), above, have been satisfied. [ ] b. The child should be discharged immediately or the facility should immediately initiate involuntary commitment proceedings because one or more of the requirements in Paragraph Three (3) have not been satisfied. ________________________________ Date ________________________________ Attorney’s signature ________________________________ Address ________________________________ Telephone number ________________________________ Guardian ad litem (signature) ________________________________ Address ________________________________ Telephone number