Ohio probate courts use Standard Probate Form 20.2 in civil commitment cases started by an Affidavit of Mental Illness (Form 20.1) under R.C. 5122.11. A clinician meets it when asked to examine the person named in the affidavit. The certificate states whether the person meets one of the first four affidavit criteria for court-ordered hospitalization or the fifth criterion for community-based treatment, with supporting findings and treatment recommendations.
A psychiatrist signs alone, or a licensed clinical psychologist and a licensed Ohio physician sign together; the physician's signature is required when the psychologist line is signed. Both personally observe and examine the person and review the affidavit.
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Certificate of Examination
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A psychiatrist, or a licensed clinical psychologist together with a licensed physician of the State of Ohio. When the psychologist signs, the physician's signature on the opposite line is required. Each signer adds their license number and contact details.
It covers a person who can benefit from community-based treatment, needs treatment to prevent deterioration likely to create a substantial risk to self or others, is unlikely to survive safely in the community without supervision, and is unlikely to participate in treatment voluntarily, as opposed to court-ordered hospitalization.