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Get DMH MH-11 2000-2024

R Relationship to or interest in proposed patient* and makes application for the emergency examination of (Please print full name of proposed person in need of treatment) of (Please print complete address of proposed person in need of treatment) *NOTE: Only the following persons may make application for an individual's emergency examination: a guardian, spouse, parent adult child, close adult relative, a responsible adult friend or person who has the individual in his or her charge or care (e.g.

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