CARE-102 - Petition to Begin Care Act Proceedings By Licensed Behavioral Health Professional Only

Summary

Petition to Begin Care Act Proceedings By Licensed Behavioral Health Professional Only

Text

Form ID: CARE-102
Title: Petition to Begin Care Act Proceedings By Licensed Behavioral Health Professional Only
Effective Date: 2025-07-01
Mandatory Form: yes
Languages: 汉语, فارسی, 한국어, español, Tiếng Việt
Info Page: https://selfhelp.courts.ca.gov/jcc-form/CARE-102
Primary Download URL: https://www.courts.ca.gov/documents/care102.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/care102c.pdf, https://www.courts.ca.gov/documents/care102f.pdf, https://www.courts.ca.gov/documents/care102k.pdf, https://www.courts.ca.gov/documents/care102s.pdf, https://www.courts.ca.gov/documents/care102v.pdf
Form Detail Page:
Petition to Begin Care Act Proceedings By Licensed Behavioral Health Professional Only
(CARE-102)
A licensed behavioral health professional may use this form to ask a court to start CARE Act proceedings on behalf of someone. This form combines the information from forms CARE-100 and CARE-101, so the licensed behavioral health professional can use this form instead of submitting both a CARE-100 and CARE-101.
Get form CARE-102
汉语
Get form CARE-102 in Chinese Simplified
(Chinese Simplified)
فارسی
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(Farsi)
한국어
Get form CARE-102 in Korean
(Korean)
español
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(Spanish)
Tiếng Việt
Get form CARE-102 in Vietnamese
(Vietnamese)
Effective: July 1, 2025
PDF Text:
CONFIDENTIAL
Form Adopted for Alternative Mandatory Use
Instead of Form CARE-100 
Judicial Council of California 
CARE-102 [New July 1, 2025]
Welfare and Institutions Code, 
§§ 5972–5975, 5977–5977.4, 5978 PETITION TO BEGIN CARE ACT PROCEEDINGS BY 
LICENSED BEHAVIORAL HEALTH PROFESSIONAL ONLY
CARE-102
ATTORNEY OR PETITIONER WITHOUT ATTORNEY STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CARE ACT PROCEEDINGS FOR (name):
RESPONDENT
PETITION TO BEGIN CARE ACT PROCEEDINGS BY 
LICENSED BEHAVIORAL HEALTH PROFESSIONAL ONLY
FOR COURT USE ONLY
CASE NUMBER:
To the petitioner: If you complete and file this form, you do not need to file Petition to Begin CARE Act Proceedings (form CARE-100) 
or Mental Health Declaration—CARE Act Proceedings  (form CARE-101). (See Cal. Rules of Court, rule 7.2221(a), (b)(1).)
1. I (enter your name here):
am 18 years of age or older and a licensed behavioral health professional who is or has been, within the past 30 days, treating or 
supervising the treatment of the respondent.
For the reasons described in this petition, including any attachments, I am asking the court to begin CARE Act proceedings for the 
respondent.
2. a. I am a licensed behavioral health professional as defined by the CARE Act (Welf. and Inst. Code, § 5971(l) as a (check 
one):
(1) physician.
(2) psychologist.
(3) clinical social worker.
(4) marriage and family therapist.
(5) professional clinical counselor.
b. My license number is (if applicable):
3. I have interacted with the respondent as follows (describe when (give the date) you last interacted with them, and what 
happened when you interacted with the respondent):
4. a. The respondent lives or was last found at (give the respondent's address if they have one and you know it, including a post 
office box where they get mail; otherwise, describe where the respondent lives, the last locations where they were staying, or 
locations where they are frequently found):
b. The respondent's other contact information is:
(telephone number, if any): The respondent does does not respond to text messages.
(email address, if any):
c. I believe that the best ways to contact the respondent are (check all that apply):
by visiting them in person(1)
(2) by calling them on the phone
(3) by sending them text messages
(4) by sending them email
(5) by sending them mail
(6) other (describe):
d. The respondent needs assistance reading speaking English.
(specify language(s)):The respondent's preferred language is
hearing or understanding
Page 1 of 4

CONFIDENTIAL
CARE-102 [New July 1, 2025] PETITION TO BEGIN CARE ACT PROCEEDINGS BY 
LICENSED BEHAVIORAL HEALTH PROFESSIONAL ONLY
CARE-102
CARE ACT PROCEEDINGS FOR (name):
RESPONDENT
CASE NUMBER:
5. The respondent (check a or b; if you check b, you must also check either (1) or (2)):
a. Is a resident of the county in which this petition is filed.
b. Is not a resident of the county in which this petition is filed.
(Enter respondent's county of residence, if you know it):
(1) The respondent is currently located in the county in which this petition is filed.
(2) The respondent is a defendant or respondent in a criminal or civil proceeding pending in the superior court of the 
county in which this is filed.
6. I (complete a or b; date of most recent examination or attempt must be no more than 60 days before the filing of the petition):
a. Examined the respondent on (date): .
b. Attempted to examine the respondent on (include all dates): , but was unsuccessful
because the respondent would not submit to an examination. 
(Describe in detail each attempt you made to examine the respondent, the nature of the respondent's lack of cooperation, 
and any other factors that prevented you from examining the respondent):
7. It is my professional opinion that the respondent meets the clinical criteria to be eligible for CARE Act proceedings. My opinion is 
based on (check all that apply):
a. The results of my examination of the respondent.
b. The results of an examination of the respondent by another licensed behavioral health professional.
(name):
(address):
(phone number): (email address):
(license number): (profession):
c. Other sources of information described below in Attachment 7.
8. Facts and opinions supporting my opinion that the respondent meets each of the clinical criteria in Welfare and Institutions Code 
section 5972 are provided (check one):
a. In item 9. (If you need more space for any of item 9, attach additional pages as Attachment 9a, Attachment 9b, etc.)
b. In an attached declaration labeled "Attachment 9." (Skip item 9, and go to item 10.)
9. It is my professional opinion that the respondent meets each of the requirements below in items 9a to 9f.
a. The respondent has a diagnosis of schizophrenia spectrum disorder or another psychotic disorder in the same class, as defined 
in the current Diagnostic and Statistical Manual of Mental Disorders. (Explain below):
b. The respondent is currently experiencing a serious mental disorder, as defined in Welfare and Institutions Code  
section 5600.3(b)(2), because the disorder:
(1) Is severe in degree and persistent in duration;
(2) May cause, or has caused, behavior that interferes substantially with the respondent's primary activities of daily living; and
(3) May result, or has resulted, in the respondent's inability to maintain stable adjustment and independent functioning without 
treatment, support, and rehabilitation for a long or indefinite period.
(Describe the seriousness, length, and effects of the respondent's mental disorder below):
Page 2 of 4

CONFIDENTIAL
CARE-102 [New July 1, 2025] PETITION TO BEGIN CARE ACT PROCEEDINGS BY 
LICENSED BEHAVIORAL HEALTH PROFESSIONAL ONLY
CARE-102
CARE ACT PROCEEDINGS FOR (name):
RESPONDENT
CASE NUMBER:
9. c. The respondent is not currently stabilized in ongoing voluntary treatment. (Describe the respondent's current condition and any 
ongoing treatment below):
d. At least one of the following is true (complete (1) or (2) or both):
(1) The respondent is unlikely to survive safely in the community without supervision and the respondent's condition is 
substantially deteriorating. (Explain why the respondent is unlikely to survive safely in the community, describe the 
type of supervision the respondent would need to survive safely, and describe how the respondent's physical or 
mental condition has recently grown worse):
(2) The respondent needs services and supports to prevent a relapse or deterioration that would be likely to lead to grave 
disability or serious harm to the respondent or others. (Describe the services and supports needed by the respondent 
and explain why the respondent would become gravely disabled or present a risk of harm to self or others without 
them):
e. Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the respondent's 
recovery and stability. (Explain why no other less restrictive treatment plan would work as well for the respondent):
f. The respondent is likely to benefit from participation in a CARE plan or CARE agreement because (explain below):
10. OPTIONAL: Other information (if applicable, check any of the following statements that are true, and give the requested 
information if you know it):
a. The respondent needs interpreter services or an accommodation for a disability. (If you know, describe what they need):
b. The respondent is served by a regional center. (If you know, give the center's name and the services it provides to them):
c. The respondent is or was a member of the state or federal armed services or reserves. (If you know, give branch name):
Page 3 of 4

CONFIDENTIAL
For your protection and privacy, please press the Clear 
This Form button after you have printed the form.
CARE-102 [New July 1, 2025] PETITION TO BEGIN CARE ACT PROCEEDINGS BY 
LICENSED BEHAVIORAL HEALTH PROFESSIONAL ONLY
Page 4 of 4
CARE-102
CARE ACT PROCEEDINGS FOR (name):
RESPONDENT
CASE NUMBER:
10. d. The respondent is an enrolled member of a federally recognized Indian tribe. (If you know, give the tribe's name and
mailing address:
e. The respondent is receiving services from a California Indian health services program, a California tribal behavioral health 
department, or a California tribal court. (If you know, give the name and mailing address of the program, department, or
court):
f. The respondent is within a juvenile court's dependency, delinquency, or transition jurisdiction. (If you know, provide the 
(1) Court:
(2) Case number:
(3) The respondent's attorney in the juvenile court proceeding (name):
(mailing address):
(telephone number): (email address):
following):
g. The respondent has a court-appointed conservator. (If you know, provide the following):
(1) Court:
(2) Case number:
(3) The respondent's attorney in the conservatorship proceeding (name):
(mailing address):
(telephone number): (email address):
11. Court referral (complete this item only if it applies; if you don't know some of the requested information, leave that part blank):
This petition is filed in response to a referral of the respondent from another court proceeding.
a. Court, department, and judicial officer:
b. Case number:
c. Type of proceeding from which the respondent was referred (check one):
(1) Mental competence proceeding arising from a criminal prosecution (Pen. Code, §§ 1370, 1370.01)
(2) Assisted outpatient treatment (Welf. & Inst. Code, §§ 5346–5348)
(3) Lanterman-Petris-Short Act conservatorship (Welf. & Inst. Code, §§ 5350–5372)
d. The referral order is attached and labeled as Attachment 11 (optional).
e. The respondent's attorney in the referring proceeding (name):
(mailing address):
(telephone number): (email address):
12. Number of pages attached:
Date:
(TYPE OR PRINT NAME OF ATTORNEY, IF ANY)
 (SIGNATURE OF ATTORNEY, IF ANY)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME OF PETITIONER)
 (SIGNATURE OF PETITIONER)

Retrieval chunks

• #1

  Form ID: CARE-102 Title: Petition to Begin Care Act Proceedings By Licensed Behavioral Health Professional Only Effective Date: 2025-07-01 Mandatory Form: yes Languages: 汉语, فارسی, 한국어, español, Tiếng Việt Info Page: https://selfhelp.courts.ca.gov/jcc-form/CARE-102 Primary Download URL: https://www.courts.ca.gov…

• #2

  am 18 years of age or older and a licensed behavioral health professional who is or has been, within the past 30 days, treating or supervising the treatment of the respondent. For the reasons described in this petition, including any attachments, I am asking the court to begin CARE Act proceedings for the responden…

• #3

  6. I (complete a or b; date of most recent examination or attempt must be no more than 60 days before the filing of the petition): a. Examined the respondent on (date): . b. Attempted to examine the respondent on (include all dates): , but was unsuccessful because the respondent would not submit to an examination. …

• #4

  CARE-102 CARE ACT PROCEEDINGS FOR (name): RESPONDENT CASE NUMBER: 9. c. The respondent is not currently stabilized in ongoing voluntary treatment. (Describe the respondent's current condition and any ongoing treatment below): d. At least one of the following is true (complete (1) or (2) or both): (1) The respon…

• #5

  e. The respondent is receiving services from a California Indian health services program, a California tribal behavioral health department, or a California tribal court. (If you know, give the name and mailing address of the program, department, or court): f. The respondent is within a juvenile court's dependency, …