Form 4-934. Petition for enforcement order.

[For use with Section 43-1-15(G) NMSA 1978] STATE OF NEW MEXICO COUNTY OF _______________ ________________ DISTRICT COURT In the Matter of _______________________, SI No. _______ PETITION FOR ENFORCEMENT ORDER Petitioner, ___________________ under Section 43-1-15 NMSA 1978, states the following. 1. Petitioner was appointed as treatment guardian for Respondent, _____________________, on _____________ (date) in Case No. _________________. 2. Petitioner’s appointment as treatment guardian shall terminate on __________ (date). 3. Respondent is currently residing at ____________________________________ (Respondent’s last-known address). 4. Respondent has a mental disorder as defined by the New Mexico Mental Health Code, Section 43-1-3(O) NMSA 1978, and is currently diagnosed as follows: ______________________________________________________________________ ______________________________________________________________________ 5. Respondent has been prescribed the following medication(s), on the following date(s), by the following authorized prescriber(s): Medication Date Prescriber (name and contact info) _________________________ ___________ _____________________________ _________________________ ___________ _____________________________ _________________________ ___________ _____________________________ _________________________ ___________ _____________________________ 6. Petitioner’s last contact with Respondent was on ____________________ (date) by _____________________ (type of contact, e.g., in person, by telephone, etc.). 7. Petitioner’s last contact with the authorized prescriber who prescribed the medication that is the subject of this petition was on ______________________ (date). 8. Respondent’s last known contact with the authorized prescriber, a mental health practitioner, or a community provider was on ______________________ (date). 9. Respondent did not comply with Petitioner’s treatment decision about the following medications, on the following date(s): Medication Date _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ 10. Petitioner made the following efforts to engage Respondent to comply with Petitioner’s treatment decision(s): __________________________________________ _____________________________________________________________________ _____________________________________________________________________ 11. Respondent responded to the efforts described in Paragraph 10 as follows: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 12. Respondent reports taking medication(s) last on ____________________ (date). 13. The following individuals report that Respondent last took medication(s) on the following date(s): Name of individual Medication Date ___________________________ _____________________ _________ ___________________________ _____________________ _________ ___________________________ _____________________ _________ ___________________________ _____________________ _________ 14. Petitioner has weighed the following risks and benefits about filing this petition: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 15. If this petition is not granted, the following outcome is likely for Respondent: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 16. The following options are available for administering the medication(s) in question to Respondent: _________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 17. Respondent has been ordered to comply with previous treatment decisions as follows: ______________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 18. This enforcement order should remain in effect until ______________________ (date) because _________________________________________________________ WHEREFORE, Petitioner requests an order to enforce the following treatment decision(s): ____________________________________________________________ _____________________________________________________________________ The order [ ] should [ ] should not authorize a peace officer to take Respondent into custody and to transport Respondent to an evaluation facility. The order [ ] should [ ] should not authorize the evaluation facility to forcibly administer treatment. Respectfully submitted, _________________________________