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\dpx9000\dpy40\dpxsize0\dpysize540\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft-360\shptop40\shpright10800\shpbottom760\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz4\shplid1044 {\sp{\sn shapeType}{\sv 202}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lTxid}{\sv 262144}}{\sp{\sn hspNext}{\sv 1044}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8720346 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8720346\charrsid1985973 Age:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1985973\charrsid16539715 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8720346 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid15887501\charrsid1985973 Gender:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15887501 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8720346 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8720346\charrsid1985973 Race / Ethnicity}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8720346 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15887501 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1985973 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid11075876 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11075876\charrsid1985973 English speaking}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid11075876 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1713229 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid15887501\charrsid1985973 DOB:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1713229 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15887501 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1713229 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid1978755\charrsid1985973 Height}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid12124746\charrsid1985973 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid3870420 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1713229 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3870420\charrsid3870420 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid1713229 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid5178439\charrsid1985973 Weight}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8720346 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11367355 ( ) M ( ) F}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11075876 ( ) Yes ( ) No }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755\charrsid3870420 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par S}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755\charrsid8720346 \par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8196\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8720346 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8720346\charrsid1985973 Age:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 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{\shp{\*\shpinst\shpleft5940\shptop40\shpright5940\shpbottom760\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz7\shplid1045{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}} {\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8199\dpline\dpptx0\dppty0\dpptx0\dppty720 \dpx5940\dpy40\dpxsize0\dpysize720\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft7560\shptop40\shpright7560\shpbottom760\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz8\shplid1046 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}} {\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8200\dpline\dpptx0\dppty0\dpptx0\dppty720\dpx7560\dpy40\dpxsize0\dpysize720\dplinew15\dplinecor0\dplinecog0\dplinecob0} }}{\shp{\*\shpinst\shpleft1980\shptop98\shpright1980\shpbottom818\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz6\shplid1047{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}} {\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8198\dpline\dpptx0\dppty0\dpptx0\dppty720\dpx1980\dpy98\dpxsize0\dpysize720\dplinew15\dplinecor0\dplinecog0\dplinecob0}}} {\shp{\*\shpinst\shpleft720\shptop98\shpright720\shpbottom818\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz5\shplid1048{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}} {\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8197\dpline\dpptx0\dppty0\dpptx0\dppty720 \dpx720\dpy98\dpxsize0\dpysize720\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1978755\charrsid1978755 \par {\*\bkmkstart Dropdown1}}{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15938496 FORMDROPDOWN }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4464485 {\*\datafield 66800000140000000944726f70646f776e310000000000000000000000000000000000000000000a00}{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20{\*\ffname Dropdown1}\ffdefres0}}}}{\fldrslt }}\sectd \pgnrestart\pgnstarts11\linex0\headery540\endnhere\sectlinegrid360\sectdefaultcl\sectrsid5916619\sftnbj {\*\bkmkstart Dropdown2}{\*\bkmkend Dropdown1}{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15938496 FORMDROPDOWN }{ \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 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\f1\fs20\insrsid15938496 FORMDROPDOWN }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4464485 {\*\datafield 66800000140000000944726f70646f776e340000000000000000000000000000000000000000000a00}{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20{\*\ffname Dropdown4}\ffdefres0}}}}{\fldrslt }}\sectd \pgnrestart\pgnstarts11\linex0\headery540\endnhere\sectlinegrid360\sectdefaultcl\sectrsid5916619\sftnbj {\*\bkmkstart Dropdown5}{\*\bkmkend Dropdown4}{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15938496 FORMDROPDOWN }{ \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4464485 {\*\datafield 66800000140000000944726f70646f776e350000000000000000000000000000000000000000000a00}{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20{\*\ffname Dropdown5}\ffdefres0}}} }{\fldrslt }}\sectd \pgnrestart\pgnstarts11\linex0\headery540\endnhere\sectlinegrid360\sectdefaultcl\sectrsid5916619\sftnbj {\*\bkmkstart Dropdown6}{\*\bkmkend Dropdown5}{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15938496 FORMDROPDOWN }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4464485 {\*\datafield 66800000140000000944726f70646f776e360000000000000000000000000000000000000000000a00} {\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20{\*\ffname Dropdown6}\ffdefres0}}}}{\fldrslt }}\sectd \pgnrestart\pgnstarts11\linex0\headery540\endnhere\sectlinegrid360\sectdefaultcl\sectrsid5916619\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1978755\charrsid1978755 {\*\bkmkend Dropdown6} \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft-360\shptop120\shpright10800\shpbottom1740\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz10\shplid1049 {\sp{\sn shapeType}{\sv 202}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lTxid}{\sv 327680}}{\sp{\sn hspNext}{\sv 1049}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8723783\charrsid16539715 Name of Consumer\rquote s }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid3364387 Family}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid10373833 / Legal Guardian}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8723783\charrsid16539715 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10373833 ___________________________________________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10563720 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1985973\charrsid1985973 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783\charrsid15075136 Phone number of }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3364387 Family}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783\charrsid15075136 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783 _______________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10373833 __________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783\charrsid15075136 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10563720 \par \tab }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10563720\charrsid10563720 \par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8202\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8723783\charrsid16539715 Name of Consumer\rquote s }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid3364387 Family}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid10373833 / Legal Guardian}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8723783\charrsid16539715 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10373833 ___________________________________________}{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10563720 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1985973\charrsid1985973 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783\charrsid15075136 Phone number of }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3364387 Family}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783\charrsid15075136 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783 _______________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10373833 __________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8723783\charrsid15075136 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10563720 \par \tab }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10563720\charrsid10563720 \par }}\dpx-360\dpy120\dpxsize11160\dpysize1620\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1978755 \par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1978755\charrsid1978755 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft-2528\shptop28\shpright-2348\shpbottom208\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz9\shplid1050 {\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8201\dprect\dpx-2528\dpy28\dpxsize180\dpysize180 \dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft-360\shptop100\shpright10800\shpbottom11260\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz11\shplid1051 {\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lTxid}{\sv 393216}}{\sp{\sn hspNext}{\sv 1051}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14550686 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\chshdng0\chcfpat0\chcbpat17\noproof\insrsid14550686\charrsid16539715 Reason for call}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid14550686\charrsid16539715 Was force used?}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 Yes ( ) No ( ) }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid14550686\charrsid14577977 If yes, explain in narrative section of this form}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid14577977 .}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14550686\charrsid11287734 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14577977 \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 ____ 911 call }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14550686\charrsid9917686 Consumer Injuries}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14550686\charrsid9917686 Officer(s) Injuries}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 ____ Involuntary Pick up}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) None }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) None \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 ____ Wellness check - follow up}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134\delrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) Prior to law enforcement arrival ( ) Slight }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 ____ Other }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) During law enforcement encounter }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) Severe}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11287734 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\chshdng0\chcfpat0\chcbpat17\noproof\insrsid4132381\charrsid16539715 In your opinion, should a CIT officer been dispatched for this call}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\chshdng0\chcfpat0\chcbpat17\noproof\insrsid16411342\charrsid16539715 ?}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid16411342 ( }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381 ) Yes }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid16411342 ( )}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid4132381 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid9651567 No}{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid4132381 }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid16743748 If no, explain in narrative}{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid4132381 }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\lang1024\langfe1024\noproof\insrsid16411342\charrsid4132381 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid4132381 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 Consumer\rquote s Status:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 [} {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 Check all that apply]}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11287734\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid14879534\charrsid14577977 Medication compliance}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid8156540\charrsid14577977 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8156540\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid14879534\charrsid14577977 [}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid14879534\charrsid14577977 Check all that apply}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid14879534\charrsid14577977 ]}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid11287734\charrsid14577977 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16539715 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11287734\charrsid9070641 (}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ) Current mental health consumer.}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 Consumer }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 is prescribed psychiatric meds? ( ) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 Yes ( ) No ( ) U}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 nknown \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ( ) New mental health consumer. }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 If yes, is consumer compliant with meds? }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16203846 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) Yes ( ) No ( ) U}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 nknown }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8156540\charrsid11287734 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16203846 ( ) Consumer is}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11287734 on probation}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 .}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10489081\charrsid9070641 ( ) Consumer is homeless}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10489081\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid10489081\charrsid16539715 Substance Abuse:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid10489081\charrsid16539715 }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid10489081\charrsid14577977 [Check all that apply]}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid10489081\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081\charrsid14577977 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10489081 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ( ) Consumer has outstanding warrant }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 Dru}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 g use suspected? }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 Yes}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 o \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13530111\charrsid9070641 ( ) Unknown or other}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13642717\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13642717 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13530111 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13530111 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 Alcohol use suspecte}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 d? ( ) Yes }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 o \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid15075136 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid9917686\charrsid16539715 Disposition of the CIT call}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid9917686\charrsid9394449 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid9917686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid10705821 Enter as CAD Call Disposition }{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid1443725\charrsid16411342 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15075136 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 1 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 ( ) Consumer unable to be located. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 2 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 ( ) Complaint unfounded. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 3 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 ( ) Situation resolved on scene, consumer not taken into custody or transported. }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 4 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 ( ) Consu}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 mer transported to crisis unit - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 voluntary}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 5 -}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 ( ) Consumer transported to crisis unit}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 \endash with involuntary commitment petition}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7479533\charrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 6 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 ( ) Consumer transported to crisis unit \endash on emergency commitment basis. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 7 -}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 ( ) Consumer tran}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 sported to }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 medical}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 hospital }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 \endash }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 Hospital Name: ____________________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 _____________________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 ________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 8 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 ( ) Consumer}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 transported to }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10489081\charrsid9070641 psychiatric }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 hospital}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 \endash }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 with involuntary commitment petition.}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 9 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 ( ) Consumer transported to psychiatric hospital \endash on emergency commitment basis. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 10 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ( ) Consumer transported to other location (home, shelter, bus depot, etc.) }{\rtlch\fcs1 \ab\ai\af1\afs18 \ltrch\fcs0 \b\i\f1\fs18\insrsid1443725\charrsid9070641 [explain in narrative section]}{\rtlch\fcs1 \ai\af1\afs18 \ltrch\fcs0 \i\f1\fs18\insrsid1443725\charrsid9070641 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9394449 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 11 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 ( ) Consumer arrested and }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11281070\charrsid9070641 transported to jail. List the charges:}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 ________________________________________________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11281070 \par }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\insrsid9070641\charrsid9070641 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11281070 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid15075136 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11281070\charrsid16539715 Prior to CIT}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15489931 : C}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 ould you have taken}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070\charrsid11281070 this consumer}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 to jail}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070\charrsid11281070 ?}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11281070 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) Y}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11075876 es }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16022373 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11075876 ( ) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 o \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 If yes, what would have been the charges?_______________________________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ______________________________ }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686\charrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid6191555\charrsid14577977 Officer Observations}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid6191555\charrsid14577977 :} {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid11075876\charrsid14577977 [Check all that apply}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid16539715\charrsid14577977 and complete narrative on back of form}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid11075876\charrsid14577977 ]}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid13784140\charrsid14577977 \par }{\rtlch\fcs1 \ab\af1\afs16 \ltrch\fcs0 \b\f1\fs16\insrsid10705821\charrsid14577977 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 (}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13047325\charrsid9070641 ) Violent \endash assaulted someone}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Appears very anxious or fearful }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3146132\charrsid9070641 (}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid8869184\charrsid9070641 ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Visual hallucinations}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 \par ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13047325\charrsid9070641 Physically threatened others}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Sad expression or crying }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Talk}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 s to self / auditory }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 hallucinations}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid5336331\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13047325\charrsid9070641 )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Verbally threatening to others }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Speaks very rapidly or uncontrollably }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Appears to have delusions}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Hostile, belligerent or argumentative}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Incoherent or illogical speech}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Seems confused or disoriented }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 ( ) Attempted to kill or harm self}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Restless / hyperactive / agitated }{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Unsteady gait / difficulty walking}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 \par ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Threatened to hurt or kill self}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 ( ) Sexually }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid8869184\charrsid9070641 inappropriate behavior }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 ( }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Inappropriate attire for the weather \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Doesn\rquote t answer questions or mute }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid2640357\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Expresses inflated self importance}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Poor personal hygiene}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid5336331\charrsid9070641 Overly suspicious / paranoid }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6237417\charrsid9070641 M}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid5336331\charrsid9070641 ental retardation}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6237417\charrsid9070641 suspected }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 ( ) Presence of urine or feces \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10705821 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1985973\charrsid9070641 ( ) Other}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 (Explain in Narrative)}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16539715\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16539715\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid328503 {\rtlch\fcs1 \ab\af1\afs16 \ltrch\fcs0 \b\f1\fs16\insrsid15489931 form #: CIT 06}{\rtlch\fcs1 \ab\af1\afs16 \ltrch\fcs0 \b\f1\fs16\insrsid8284738 1706}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16539715 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6904416\charrsid1985973 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15938496 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5072946 \par \par \par \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15938496 \par \par \par \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15938496\charrsid9917686 \par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8203\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14550686 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\chshdng0\chcfpat0\chcbpat17\noproof\insrsid14550686\charrsid16539715 Reason for call}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid14550686\charrsid16539715 Was force used?}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 Yes ( ) No ( ) }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid14550686\charrsid14577977 If yes, explain in narrative section of this form}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid14577977 .}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14550686\charrsid11287734 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14577977 \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 ____ 911 call }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14550686\charrsid9917686 Consumer Injuries}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14550686\charrsid9917686 Officer(s) Injuries}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 ____ Involuntary Pick up}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) None }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) None \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 ____ Wellness check - follow up}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134\delrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) Prior to law enforcement arrival ( ) Slight }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid6775134 ____ Other }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) During law enforcement encounter }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6775134 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ( ) Severe}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11287734 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\chshdng0\chcfpat0\chcbpat17\noproof\insrsid4132381\charrsid16539715 In your opinion, should a CIT officer been dispatched for this call}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\chshdng0\chcfpat0\chcbpat17\noproof\insrsid16411342\charrsid16539715 ?}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid16411342 ( }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381 ) Yes }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid16411342 ( )}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid4132381 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid9651567 No}{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid4132381 }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid16743748 If no, explain in narrative}{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\lang1024\langfe1024\noproof\insrsid4132381\charrsid4132381 }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\lang1024\langfe1024\noproof\insrsid16411342\charrsid4132381 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid4132381 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 Consumer\rquote s Status:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 [} {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 Check all that apply]}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11287734\charrsid14577977 }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11287734\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid14879534\charrsid14577977 Medication compliance}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid8156540\charrsid14577977 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid8156540\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid14879534\charrsid14577977 [}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid14879534\charrsid14577977 Check all that apply}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid14879534\charrsid14577977 ]}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid11287734\charrsid14577977 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16539715 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11287734\charrsid9070641 (}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ) Current mental health consumer.}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 Consumer }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 is prescribed psychiatric meds? ( ) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 Yes ( ) No ( ) U}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 nknown \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ( ) New mental health consumer. }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 If yes, is consumer compliant with meds? }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16203846 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) Yes ( ) No ( ) U}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 nknown }{ \rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8156540\charrsid11287734 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16203846 ( ) Consumer is}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11287734 on probation}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1443725 .}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10489081\charrsid9070641 ( ) Consumer is homeless}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10489081\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid10489081\charrsid16539715 Substance Abuse:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid10489081\charrsid16539715 }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid10489081\charrsid14577977 [Check all that apply]}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid10489081\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081\charrsid14577977 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10489081 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ( ) Consumer has outstanding warrant }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14879534 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 Dru}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 g use suspected? }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 Yes}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 o \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13530111\charrsid9070641 ( ) Unknown or other}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13642717\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13642717 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13530111 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13530111 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 Alcohol use suspecte}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 d? ( ) Yes }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12739095 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10489081 o \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid15075136 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid9917686\charrsid16539715 Disposition of the CIT call}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid9917686\charrsid9394449 : }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid9917686 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid10705821 Enter as CAD Call Disposition }{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid1443725\charrsid16411342 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15075136 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 1 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 ( ) Consumer unable to be located. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 2 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 ( ) Complaint unfounded. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 3 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 ( ) Situation resolved on scene, consumer not taken into custody or transported. }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 4 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 ( ) Consu}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 mer transported to crisis unit - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 voluntary}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 5 -}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 ( ) Consumer transported to crisis unit}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 \endash with involuntary commitment petition}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7479533\charrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 6 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 ( ) Consumer transported to crisis unit \endash on emergency commitment basis. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 7 -}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 ( ) Consumer tran}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 sported to }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 medical}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 hospital }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 \endash }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 Hospital Name: ____________________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 _____________________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 ________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9917686\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 8 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 ( ) Consumer}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 transported to }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10489081\charrsid9070641 psychiatric }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 hospital}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid14359738\charrsid9070641 \endash }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 with involuntary commitment petition.}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 9 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 .}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid7633965\charrsid9070641 ( ) Consumer transported to psychiatric hospital \endash on emergency commitment basis. \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 10 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1443725\charrsid9070641 ( ) Consumer transported to other location (home, shelter, bus depot, etc.) }{\rtlch\fcs1 \ab\ai\af1\afs18 \ltrch\fcs0 \b\i\f1\fs18\insrsid1443725\charrsid9070641 [explain in narrative section]}{\rtlch\fcs1 \ai\af1\afs18 \ltrch\fcs0 \i\f1\fs18\insrsid1443725\charrsid9070641 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9394449 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 11 - }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11538290\charrsid9070641 ( ) Consumer arrested and }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11281070\charrsid9070641 transported to jail. List the charges:}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 ________________________________________________}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid11281070 \par }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\insrsid9070641\charrsid9070641 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11281070 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat18\insrsid15075136 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\chshdng0\chcfpat0\chcbpat17\insrsid11281070\charrsid16539715 Prior to CIT}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15489931 : C}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 ould you have taken}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070\charrsid11281070 this consumer}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 to jail}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070\charrsid11281070 ?}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11281070 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 ( ) Y}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11075876 es }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16022373 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11075876 ( ) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9651567 N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 o \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11281070 If yes, what would have been the charges?_______________________________}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686 ______________________________ }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14550686\charrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid14550686 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid6191555\charrsid14577977 Officer Observations}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid6191555\charrsid14577977 :} {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid11075876\charrsid14577977 [Check all that apply}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat17\insrsid16539715\charrsid14577977 and complete narrative on back of form}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid11075876\charrsid14577977 ]}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\chshdng0\chcfpat0\chcbpat18\insrsid13784140\charrsid14577977 \par }{\rtlch\fcs1 \ab\af1\afs16 \ltrch\fcs0 \b\f1\fs16\insrsid10705821\charrsid14577977 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 (}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13047325\charrsid9070641 ) Violent \endash assaulted someone}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Appears very anxious or fearful }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3146132\charrsid9070641 (}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid8869184\charrsid9070641 ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Visual hallucinations}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 \par ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13047325\charrsid9070641 Physically threatened others}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Sad expression or crying }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Talk}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 s to self / auditory }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 hallucinations}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid5336331\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13047325\charrsid9070641 )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Verbally threatening to others }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Speaks very rapidly or uncontrollably }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Appears to have delusions}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6191555\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Hostile, belligerent or argumentative}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Incoherent or illogical speech}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Seems confused or disoriented }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 ( ) Attempted to kill or harm self}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Restless / hyperactive / agitated }{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Unsteady gait / difficulty walking}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 \par ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Threatened to hurt or kill self}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 ( ) Sexually }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid8869184\charrsid9070641 inappropriate behavior }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 ( }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Inappropriate attire for the weather \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 Doesn\rquote t answer questions or mute }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid2640357\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16610398\charrsid9070641 Expresses inflated self importance}{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3825572\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 ( )}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16132050\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 Poor personal hygiene}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid23732\charrsid9070641 \par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid5336331\charrsid9070641 Overly suspicious / paranoid }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 ( ) }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6237417\charrsid9070641 M}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid5336331\charrsid9070641 ental retardation}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6237417\charrsid9070641 suspected }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{ \rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13784140\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid13380914\charrsid9070641 ( ) Presence of urine or feces \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10705821 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid884320\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid9070641 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid1985973\charrsid9070641 ( ) Other}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid6775134\charrsid9070641 (Explain in Narrative)}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid16539715\charrsid9070641 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16539715\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9070641 \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16539715\charrsid14577977 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid10705821\charrsid9070641 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid328503 {\rtlch\fcs1 \ab\af1\afs16 \ltrch\fcs0 \b\f1\fs16\insrsid15489931 form #: CIT 06}{\rtlch\fcs1 \ab\af1\afs16 \ltrch\fcs0 \b\f1\fs16\insrsid8284738 1706}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16539715 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6904416\charrsid1985973 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15938496 \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5072946 \par \par \par \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15938496 \par \par \par \par \par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15938496\charrsid9917686 \par }}\dpx-360\dpy100\dpxsize11160\dpysize11160\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog0\dplinecob0}}} {\shp{\*\shpinst\shpleft3060\shptop100\shpright3060\shpbottom1720\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz20\shplid1052{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}} {\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8212\dpline\dpptx0\dppty0\dpptx0\dppty1620 \dpx3060\dpy100\dpxsize0\dpysize1620\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par \par \par \par }\pard \ltrpar\ql \li0\ri-720\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-720\lin0\itap0\pararsid6904416 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1978755 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft-360\shptop110\shpright10800\shpbottom110\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz19\shplid1053 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}} {\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8211\dpline\dpptx0\dppty0\dpptx11160\dppty0\dpx-360\dpy110\dpxsize11160\dpysize0 \dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft3780\shptop190\shpright3780\shpbottom2170\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz12\shplid1054 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 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}{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft3780\shptop121\shpright10800\shpbottom121\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz13\shplid1056 {\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}} {\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8205\dpline\dpptx0\dppty0\dpptx7020\dppty0\dpx3780\dpy121\dpxsize7020\dpysize0 \dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid1978755 \par \par \par \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4464485 {\shp{\*\shpinst\shpleft-360\shptop101\shpright10800\shpbottom101\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz17\shplid1057 {\sp{\sn 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_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________}{\rtlch\fcs1 \ab\af1\afs32 \ltrch\fcs0 \b\fs32\ul\insrsid1779457 _______}{\rtlch\fcs1 \ab\af1\afs32 \ltrch\fcs0 \b\fs32\ul\insrsid1779457\charrsid12274728 ___}{\rtlch\fcs1 \ab\af1\afs32 \ltrch\fcs0 \b\fs32\ul\insrsid1779457 ____________________________________________ \par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1779457 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1779457 \par \par \par \par }\pard \ltrpar\qc \li0\ri0\widctlpar\brdrt\brdrdb\brdrw10\brsp20 \brdrl\brdrdb\brdrw10\brsp60 \brdrb\brdrdb\brdrw10 \brdrr\brdrdb\brdrw10\brsp80 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