Form Adopted for Mandatory Use
L-0733 (New April 11, 2019)
ELDERCARING COORDINATOR REPORT
OF AN EMERGENCY
ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NO.:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER
700 Civic Center Drive West
Santa Ana, CA 92701-4045
ELDERCARING COORDINATOR REPORT
OF AN EMERGENCY
The undersigned Eldercaring Coordinator reports an emergency to the court:
1. With notice to the parties. A party has obtained a final order or injunction of protection against domestic
violence or has been arrested for an act of domestic violence, elder abuse, neglect or exploitation.
2. Without notice to the parties. (check all that apply)
a. There is a reasonable cause to suspect the elder has been or is being abused, neglected, or
exploited, or the elder’s health, safety and well-being are in immediate jeopardy; or
b. There is a reasonable cause to suspect that a child will suffer or is suffering abuse, neglect, or
abandonment; or
c. A participant of the eldercaring coordination, or someone acting on the elder’s behalf, is expected to
wrongfully remove or is wrongfully removing the elder from the jurisdiction of the court without prior
approval of the court; or
d. It is necessary to protect any person from future acts that would constitute domestic violence or
abuse, neglect, or exploitation of an elderly or disabled adult.
3. There is a pending investigation by the Adult or Child Protective Services.
4. Describe the emergency:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
SIGNATURE OF ELDERCARING COORDINATOR
