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Or person in loco parentis of the minor he or she must certify, by signing below, that he or she believes that the minor is in such condition that immediate hospitalization is necessary and has made diligent but unsuccessful effort to locate the minor's parent, guardian, or person in loco parentis, or the parents or guardian refused to sign the application. Signature: The minor was: admitted; or denied admission , on at (date) (year) M. (time) Signed: Title: Center Director: I have expl.

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