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PETITIONER'S RESPONSIBILITIES - HAL MARCHMAN ACT (Pinellas County Clerk of the Circuit Court and Comptroller)

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PETITIONER'S RESPONSIBILITIES - HAL MARCHMAN ACT
The Hal S. Marchman Act, Florida Statute 397.01 et seq. (1993), has been passed by the Florida Legislature to address issues of substance
and alcohol abuse. A portion of that Act provides a procedure for the involuntary commitment for substance and alcohol abuse services.
BEFORE A PETITION IS FILED:
In order to avoid a court hearing, BEFORE filing a petition, you should take the following actions:
1) Find a facility in Pinellas that provide substance abuse services. (see website below)
2) YOU MUST contact the facility and ensure that a bed is or will be available, and that payment for these services has been
arranged.
3) Once you secure a bed for the patient, take the patient to the facility if he or she is willing to be voluntarily admitted.
4) He or she will then be assessed for substance or alcohol abuse. If necessary, he or she will then be admitted to the facility
and treated.
TO FIND A FACILITY:
Operation PAR, Inc., Res. Level 5, 150TH AVE N, Clearwater & Res. Level 1, 13800 66TH ST, Largo, (727) 545-7564
DACCO Behavioral Health, Inc. 348 W. Highlands Drive. Lakeland 33813 Polk (813) 384-4000 10/28/2019
Tranquil Shores, LLC, 4300 Duhme Road, Madeira Beach, 33708, (727) 391-7001
BayCare Behavioral Health, Inc., Res.l Level 2, 6040 Indiana Ave. , New Port Richey 34653, (727) 841-4200
First Step of Sarasota, Inc. 1726 18TH ST 34234-8604 Sarasota (941) 366-5333
Baycare ISU, a/k/a New Port Richey BayCare Behavioral Health, Inc. 8002 King Helie Blvd Pasco (727) 841-4200
Centerstone of Florida, Inc. 2020 26TH AVE E, BRADENTON Manatee (941) 782-4710
ACTS/GRACEPOINT2212 East Henry Avenue Hillsborough (813) 246-4899 (Central Receiving Facility)
Tampa Agency for Community Treatment Services, Inc. 8620 N. Dixon Ave Hillsborough (813) 246-4899, (Juvenile Facility)
Transformations By The Gulf LLC, 7217 GULF BLVD, St Pete Beach, 33706, (727) 498-6498
Spencer Recovery Centers Florida, Inc, 140 Corey Avenue, St Pete Beach, 33706, (949) 313-5240
Behavioral Health Management Services,Inc., 2727 W. Martin Luther King Blvd, Tampa, 33607, (727) 841-4200
Riverside Recovery of Tampa, LLC, 4004 N RIVERSIDE DR, TAMPA, 33603-3212 , ugh (813) 296-8300
Turning Point of Tampa, Inc, 6311 Sheldon Road, TAMPA, 33615, (813) 882-3003
Footprints Beachside Recovery, Inc, 151 107th Avenue, Treasure Island, 33706 (727) 954-3908
BRADENTON Centerstone of Florida, Inc. 2020 26TH AVE E 34208-7753 Manatee (941) 782-4710
Or Go to page: http://www.myflfamilies.com/service-programs/substance-abuse
or scan this QR code:
IF IT IS NECESSARY TO FILE A PETITION:
(The patient is not willing to voluntarily seek an evaluation or treatment)
There is no fee for filing a Marchman Act Petition. However, if granted, a $40.00 service fee for the Sheriff is required. You can pay this
with a credit or debit card through the sheriff’s website: govpaynow.com
[PLC # 8384, case # = Marchman]
YOU HAVE the burden of proof in any court hearing.
YOU ARE NOT entitled to a court appointed attorney.
YOU MUST PROVE that the patient is substance abuse impaired and is in need of a professional evaluation.
YOUR PETITION MUST CONTAIN THE FOLLOWING:
A full description of the patient, including height, weight, hair color and other features;
Detailed location where the patient can be found (the person must be in Pinellas County, per FS 397.681);
The name, address and phone number of the facility that is available to take the patient and the name of the person you
contacted there;
The day and time that the bed will be available.
Once on the webpage, from the Links section (on left) click on ‘For SAMH Providers.’ From there, under
the paragraph entitled “Substance Abuse Providers Currently Licensed by the Department” click on
“this listing.” This link brings you to the Department of Children and Families list.
Page 2 of 7
Information and (PFIT) Petition for Involuntary Treatment Form MA-16 See 397.693 F.S. (9/2020)
The following information is provided by the Court for informational
purposes only and does not constitute legal advice.
PLEASE NOTE:
When filing petitions in the Marchman Act Court, it is important, as the petitioner, to understand
what may be expected and to note that matters may not always be handled in the way one may
want them to be handled. This is a court, and there are certain laws and procedures that must be
followed. The respondent has certain rights, and these rights will be upheld.
1. Please make sure that all information provided is true and correct. All the information
and observations in the petition for the assessment and stabilization must be from first-
hand knowledge.
2. Please understand that in the petition the petitioner has asked the court to become
involved in the respondent’s substance abuse issues.
3. Once the assessment has been completed the petitioner has the opportunity to return to
the courthouse to file the petition for court ordered treatment. If treatment is ordered, the
court will consider all recommendations of the assessor. In some cases, the petitioner
may not agree with all the recommendations.
4. If RESIDENTIAL TREATMENT is recommended, please be aware that there may be a
very long waiting list for admission into a residential program. There is nothing the
court can do to decrease the wait time.
5. There are no lock-down residential facilities. If the respondent does not want to stay in
treatment, he or she can walk away at any time.
6. THERE IS NO FREE TREATMENT. EACH PROGRAM HAS THEIR OWN
STRUCTURED FEES. WE DO NOT HAVE ANY FUNDING ASSISTANCE IN THIS
COURT. THE RESPONDENT IS RESPONSIBLE FOR ANY TREATMENT FEES
ASSOCIATED WITH THIS COURT.
Page 3 of 7
Information and (PFIT) Petition for Involuntary Treatment Form MA-16 See 397.693 F.S. (9/2020)
MARCHMAN ACT PROCEEDINGS
Petition for Involuntary Assessment and Stabilization
Petition outlining the need for involuntary assessment and stabilization is filed.
Judge reviews petition and if appropriate a court date is set w/in 10 days (in some cases
the Judge may issue an Order for the Respondent to be transported, stabilized and
assessed without a court hearing).
Attempts are made to serve the Respondent with the petition.
At the initial hearing, the Respondent will have an attorney appointed to them.
After hearing from all parties, the Judge or general magistrate determines whether
Substance Abuse Evaluation and Stabilization is necessary. (An assessment may be done
on an in-patient or out-patient basis as ordered by the Court). If it is determined that an
assessment is not necessary, the case may be dismissed. If an assessment is ordered, the
Respondent will be given instructions as to what to do.
Petition for Involuntary Substance Abuse Treatment
Petitioner comes to the Clerk’s Office to complete the Petition for Involuntary Treatment
and submit the assessment. The petitioner is required to bring the assessment to the
Clerk’s Office within 5 days from the date the assessment is done.
The Respondent will be served with a copy of all pleadings, a Summons, and a Notice of
Hearing.
At the hearing, the Respondent will have an attorney appointed to them.
The qualified professional who conducted the assessment MUST testify at the hearing.
It is the Petitioner’s responsibility to request the professional appear and/or subpoena the
professional as a witness. Based on the recommendations outlined in the assessment and
after hearing from all parties, the Judge or general magistrate determines whether
Substance Abuse treatment is warranted. (Treatment may be ordered on an in-patient or
out-patient basis).
Initial treatment is for 90 days and subsequent renewals are every 90 days.
Any treatment ordered must be paid for by the Respondent or the Respondent’s
family.
*The Petitioner has the responsibility of attending all court hearings related to the Respondent’s
Treatment unless excused by the Judge.
Page 4 of 7
Information and (PFIT) Petition for Involuntary Treatment Form MA-16 See 397.693 F.S. (9/2020)
IN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT,
IN AND FOR PINELLAS COUNTY, FLORIDA
PROBATE DIVISION
IN RE: _____________________________
REF #: _____________________________ UCN: ___________________________________
PETITION FOR INVOLUNTARY SERVICES
By authority of Chapter 397, Florida Statutes
I, ___________________________ being duly sworn, am filing this sworn statement requesting a court
order for the involuntary services of _________________________________ (hereinafter referred to
PRINT NAME OF RESPONDENT
as Respondent).
Is the Respondent eighteen (18) years of age or older? [ ]YES [ ]NO Age (if known): ______
Relationship of Petitioner to Respondent:
Spouse Parent (Minors)
Guardian Relative ________________
Legal Guardian of Minor Director of Licensed Service Provider
An adult who has direct personal knowledge of the Respondent’s substance abuse impairment and his/her
prior course of assessment and treatment.
I SWEAR that the answers to the following questions are given honestly, in good faith, and to the best of my
knowledge.
1. a. Petitioner Phone (including area code): ______________________________
b. Petitioner email address : __________________________________________
c. Petitioner lives at (print full residence address):
____________________________________________________________________________________
Street Address City State Zip
The Respondent lives at, or may be found at:
_____________________________________________________________________________________
Street Address City State Zip
_____________________________________________________________________________________
Street Address City State Zip
Respondent’s email address, if known:
_____________________________________________________________________________________
I, ____________________________ hereby state that I have personally observed the behavior of
Print Name of Petitioner
___________________________, and have a good faith reason to believe that said respondent is
Print Name of Respondent
substance abuse impaired as defined under Florida Statutes Section 397, and allege:
2. Petitioner alleges that the Respondent meets the criteria for involuntary admission as provided in Florida
Statutes Section 397.6951 in that:
Page 5 of 7
Information and (PFIT) Petition for Involuntary Treatment Form MA-16 See 397.693 F.S. (9/2020)
(a) Respondent is substance abuse impaired, as evidenced by: _________________________________
____________________________________________________________________________________
________________________________________________________________ AND
(b) Because of such impairment the Respondent has lost the power of self-control with respect to substance
abuse, as evidenced by: _______________________________________________________________
_____________________________________________________________________________________
_______________________________________________________________ AND
(c) Respondent has inflicted or is likely to inflict physical harm on himself or others unless the court orders the
involuntary services, as evidenced by: ____________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
OR,
The Respondent’s refusal to voluntarily receive care is based on judgment so impaired by reason of
substance abuse that the Respondent is incapable of appreciating his/her need for care and making a rational
decision regarding his/her need for care as evidenced by: __________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. Petitioner further alleges: (Petitioner must allege at least one of the following:)
Respondent has been assessed by a qualified professional within 5 days;
Respondent has been subject to involuntary assessment and stabilization pursuant to F.S.397.6818 within
the previous 12 days;
Respondent has been placed under protective custody pursuant to F.S. 397.677 within the previous 10
days;
Respondent has been subject to an emergency admission pursuant to F.S. 397.679 within the previous 10
days; or
Respondent has been subject to alternative involuntary admission pursuant to F.S. 397.6822 within the
previous 12 days.
4. The Respondent is:
Represented by an attorney:
Name: _______________________________________ Phone Number: _________________
Address: ____________________________________________________________________
Not represented by an attorney.
Unknown whether the Person is represented by an attorney.
5. Respondent:
Has assets sufficient to pay attorney fees.
Does not have assets sufficient to pay attorney fees.
Unknown whether the Respondent has assets sufficient to pay attorney fees.
6. An assessment was performed on the Person by a qualified professional, at:
Facility or Professional’s Name and Address and Phone Number _______________________________
____________________________________________________________________________________
____________________________________________________________________________________
The assessment was performed on (date) ______________.
The findings and recommendations of the assessment performed by the qualified professional are:
_____________________________________________________________________________________
_____________________________________________________________________________________
Page 6 of 7
Information and (PFIT) Petition for Involuntary Treatment Form MA-16 See 397.693 F.S. (9/2020)
PLEASE PROVIDE THE FOLLOWING IDENTIFYING INFORMATION ABOUT THE RESPONDENT:
County of Residence: __________________ Date of Birth: _______________ Age: _______________
Race: ________________________ Sex: ______________ SS#: _____________________________
Attach a picture of the Respondent if possible. Picture attached: [ ] YES [ ] NO
Height: __________ Weight: _____________ Hair Color: _____________ Eye Color: __________
1. Does Respondent have access to any weapons: [ ] YES [ ] NO [ ] UNKNOWN
If yes, please describe:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. Is the Respondent violent now? [ ] YES [ ] NO [ ] UNKNOWN
If yes, please describe: ________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
3. Has the Respondent been violent toward anyone, including law enforcement, in the recent past?
[ ] YES [ ] NO [ ] UNKNOWN
If yes, please describe: ________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
WHERE IS THE SUBJECT EMPLOYED? (If applicable)
__________________________________________________________________________________________________
(Name of Company) (Address, if known)
IF THE SUBJECT IS OVER 18, HAS THE SUBJECT EVER BEEN DECLARED INCOMPETENT?
[ ] YES [ ] NO If yes, Guardian’s
Name_____________________________________________________________
__________________________________________________________________________________________________
(Guardian’s Full Mailing Address and Phone Number)
DOES THE SUBJECT HAVE ANY CRIMINAL CHARGES PENDING?
[ ] NO [ ] YES IF YES – ARE THEY [ ] MISDEMEANOR [ ] FELONY [ ] NOT SURE
IS THE SUBJECT CURRENTLY INCARCERATED…………………………. [ ] YES [ ] NO
IS THE SUBJECT CURRENTLY ON PROBATION? …..................................... [ ] YES [ ] NO
IS THERE ANY PENDING DOMESTIC VIOLENCE CASE? ………………… [ ] YES [ ] NO
IS THERE ANY PENDING BAKER ACT CASE? …………………………….. [ ] YES [ ] NO
IS THERE ANY PENDING DEPENDENCY CASE? …....................................... [ ] YES [ ] NO
IS THIS PERSON A VETERAN…………………………………………………. [ ] YES [ ] NO
DOES THE SUBJECT REQUIRE AN INTERPRETER? IF SO, WHAT LANGUAGE?
__________________________________________________________________________________________________
IF YOU HAVE ANSWERED “YES” TO ANY OF THE ABOVE, PLEASE EXPLAIN BELOW
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Page 7 of 7
Information and (PFIT) Petition for Involuntary Treatment Form MA-16 See 397.693 F.S. (9/2020)
I have contacted ____________________________ at ________________________________,
(Person with whom you spoke) (Name of Facility)
whose phone number is ______________________________who stated that the above named
receiving facility is willing to provide involuntary services.
I hereby petition this Court to enter an Order for Involuntary Services of the Respondent.
Under penalties of perjury I declare that I have read the foregoing and the facts alleged are true and
correct to the best of my knowledge and belief.
SIGNATURE OF AFFIANT/PETITIONER: _________________________________ Date: ___________
SWORN TO AND SUBSCRIBED before me this _______day of ________________, 20_____,
KEN BURKE, CLERK OF THE CIRCUIT COURT,
PINELLAS COUNTY, FLORIDA
By: ___________________________
Deputy Clerk
OR
SWORN TO AND SUBSCRIBED before me this _______day of _________________, 20____,
by ________________________, who is personally known to me OR presented _______________________ as
identification.
___________________________________ My commission expires: __________________
Notary Public – State of Florida Date
NOTE: All information pertaining to the person is confidential and is protected from disclosure
under the authority found in s. 397. 501 (7), Florida Statutes, and 42 Code of Federal Regulations,
Part 2.
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PETITIONER'S RESPONSIBILITIES - HAL MARCHMAN ACT (Pinellas County Clerk of the Circuit Court and Comptroller)

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