CIRCUIT COURT DISTRICT COURT OF MARYLAND FOR ............................................
Located at.................................................................................... Case No. ...............................................
PETITION FOR EMERGENCY EVALUATION
(Maryland Code, Health-General Article § 10-620 et seq.)
The Petitioner, ..........................................................................................................., requests that this Court order an
emergency evaluation of.......................................................................................................................................... and
in support of this Petition states as follows:
1. Petitioner: Address ....................................................................................................................................................
Cell Phone/Pager # .................................Home Phone ....................................Work Phone ....................................
Relationship to or interest in evaluee ........................................................................................................................
2. Evaluee: Address........................................................................................................................... DOB ..................
Sex............ Race............. Ht. ............... Wt. ............... Hair.................. Eyes................. Complexion......................
Driver’s License No...........................................................................Other..............................................................
3. If not Petitioner, name of spouse, child, parent, or other relative, or other individual interested in the evaluee:
Name.................................................................................... Relationship ................................................................
Address.......................................................................................