To submit this form, provide a copy to the court, the respondent if possible, and the licensed physician conducting the evaluation. Include the original form for the court's records. Ensure all sections are filled out correctly and signed before submission. The form can be submitted in person at the relevant courthouse or sent via mail to the court's address. Always keep a copy for your records. Advice: Ensure clarity and accuracy in all provided information to avoid delays in processing.

There are no specific important dates associated with Form DC-491 for 2024 and 2025. The form should be used whenever there is a need for medical emergency custody of a patient.

The purpose of Form DC-491, the Medical Emergency Custody Petition, is to provide a legal document for licensed physicians or magistrates to request medical emergency custody for a patient. This form is crucial when a patient is incapable of giving informed consent due to a mental or physical condition that requires immediate attention. By completing this form, medical professionals can ensure that necessary medical interventions are provided promptly and legally. Form DC-491 is used to document the professional assessment of a patient's condition and their need for urgent medical care. This includes details about the patient's mental or physical incapacity, refusal or inability to consent to treatment, and the medical interventions deemed necessary to prevent imminent and irreversible harm. Completing this form ensures compliance with legal requirements and safeguards the patient's well-being. In summary, Form DC-491 is an essential tool for healthcare providers and legal professionals in securing medical emergency custody for patients in critical situations. It outlines the necessary steps to obtain informed consent, documents the patient's condition, and facilitates the timely provision of medical care. Properly completing this form is vital to ensuring that patients receive the care they need in emergency circumstances.

• 1. Court Case Number: Insert court case number.
• 2. Court Name: Insert court name and check the appropriate box.
• 3. Patient Name and Address: Provide the name and permanent address of the patient/respondent.
• 4. Physician Name: Insert the name of the licensed physician initiating the petition.
• 5. Patient Condition: Describe the patient's injury or illness.
• 6. Patient Location: Insert the current location of the patient.
• 7. Known Physical or Mental Condition: Check this box and indicate a known condition affecting consent.
• 8. Unknown Physical or Mental Condition: Check this box and insert symptoms of an unknown condition.
• 9. Medical Interventions: Describe the testing, observation, or treatment needed.
• 10. Religious Beliefs or Values: Check this box and describe any religious beliefs or values affecting treatment.
• 11. Date and Time: Insert date and time when the petition is signed or requested.
• 12. Physician Signature: Signature or printed name of the physician requesting the order.
• 13. Transcription Agreement: Check this box if the physician agrees with the transcription.
• 14. Magistrate Signature: Signature of magistrate taking the oral petition, if applicable.

If you fail to submit this form, the patient may not receive the necessary medical custody and care in a timely manner. This can lead to worsening of the patient's condition and potential legal repercussions for the physician.

• Delayed Medical Care: Failure to submit may result in delayed or denied medical care for the patient.
• Legal Repercussions: Physicians may face legal consequences for not following proper procedures.
• Patient Harm: Without timely submission, the patient may suffer from preventable harm or deterioration of their condition.

• 1. Emergency Medical Situations: When a patient needs immediate medical intervention and cannot consent.
• 2. Mental Health Crises: For patients experiencing severe mental health issues affecting decision-making.
• 3. Refusal of Treatment: When a patient refuses treatment, but their condition requires urgent care.
• 4. Incapacitated Patients: For patients who are physically or mentally incapacitated to make decisions.
• 5. Legal Guardianship: To establish temporary custody for providing necessary medical treatment.