This declaration supports a CARE Act petition (CARE-100) in California superior court with a licensed behavioral health professional's view on whether the respondent meets the diagnostic criteria. The clinician states they examined the respondent within 60 days of filing, or tried and was refused, then explains each criterion: qualifying psychotic disorder, severity, stabilization status, and likely benefit from a CARE plan.
A California-licensed physician, psychologist, clinical social worker, marriage and family therapist, professional clinical counselor, nurse practitioner or physician assistant completes items 1 to 8 and signs under penalty of perjury. A professional granted a DHCS licensure waiver may also sign.
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Mental Health Declaration—CARE Act Proceedings
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A licensed behavioral health professional for whom the examination is within the scope of license: a California physician, psychologist, clinical social worker, marriage and family therapist, professional clinical counselor, nurse practitioner or physician assistant. Someone granted a licensure waiver under Welfare and Institutions Code 5751.2 may also sign.
Check item 5b and list the dates you attempted the examination, then explain in item 6 how many attempts were made, what kind, how the respondent responded and the outcome of each. Item 7 still asks why you have reason to believe the criteria are met.
The Judicial Council posts translations in Spanish, Chinese, Korean, Vietnamese, Khmer, Farsi and Tagalog for information only. The mandatory form is the English CARE-101, revised July 1, 2026, which is filed with the petition.