IVC Petition Builder — JFK ADATC

IVC Petition — Facts Section Reference

JFK ADATC — Buncombe County, NC • Generated from IVC Petition Builder

Step 1 of 4

Select Basis for Dangerousness

Check all that apply. You may select from both categories if the respondent is dangerous to self and others.

Dangerous to Self

Inability to care for self + probability of physical debilitation

Attempted or threatened suicide + probability of suicide

Self-mutilation + probability of serious repetition

Dangerous to Others

Inflicted/attempted/threatened serious bodily harm + probability of repetition

Created substantial risk of serious bodily harm + probability of repetition

Extreme destruction of property + probability of repetition

Step 2 of 4

Guided Fact Builder

Complete each section below based on your selected pathways. Be as specific as possible — use dates, times, direct quotes, and observable behaviors. Click phrases from the Word Bank (right panel) to insert them into text areas.

1 Inability to Self-Care + Debilitation

Describe specific self-care deficits observed:

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Describe probability of debilitation:

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2 Suicide — Attempt or Threat

Describe the specific suicidal statement, threat, or attempt:

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When did this occur? (date/time):

Describe any prior suicide attempts:

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Why is there a reasonable probability of suicide without treatment?

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3 Self-Mutilation

Describe the specific self-harm behavior:

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When did this occur? (date/time):

Prior self-harm history:

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4 Bodily Harm to Others

Describe the specific act of harm, threat, or attempt:

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When did this occur? (date/time):

Why is there a reasonable probability of repetition?

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5 Substantial Risk of Serious Bodily Harm

Describe how the patient created substantial risk:

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When did this occur? (date/time):

Why is there a reasonable probability of repetition?

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6 Extreme Property Destruction

Describe the specific destruction:

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When did this occur?

Why is there a reasonable probability of repetition?

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★ Mental Illness Evidence

Describe observable symptoms of mental illness:

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Relevant psychiatric history:

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Step 3 of 4

Additional Context

Any additional facts or observations:

Name of person other than petitioner who may testify (optional):

📋 Master Combined Statement

Everything you've entered above is automatically combined here into one narrative. You can edit this text directly. Copy it and paste into the facts section of the AOC-SP-300 form.

⚠️ If applicable: Patient exceeds the capability of this hospital

If the patient's behaviors or clinical needs exceed what JFK ADATC can safely manage, check the applicable boxes below. This language will be appended to your Master Combined Statement.

Behavioral / safety concerns — Patient's behavior poses a safety risk that exceeds the capabilities of this facility (e.g., persistent aggression, elopement risk, inability to maintain a safe environment on an unlocked or minimally secured unit). Need for restraints and/or forced medications — Patient requires physical restraints and/or involuntary administration of medications, which this hospital is not capable of providing.

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📄 Download Blank Form

Pre-filled PDF inserts your Master Combined Statement into the "facts" field of the petition documentation. JFK ADATC address and Buncombe County are pre-populated. Review all fields before printing.

Step 4 of 4

Petition Strength Check

This heuristic check scans your entries for common deficiencies. It is not a legal validity check.

✗ Specific observable behaviors described (not just conclusions)
✗ Dates and times included
✗ Direct quotes from patient included (if applicable)
✗ Probability of harm/debilitation addressed
✗ Prior history referenced (if applicable)
✗ Mental illness evidence described

Generated Output

AOC-SP-300 Form Guidance

Facts Section — For AOC-SP-300

Disclaimer: This tool is a writing aid only. It does not constitute legal advice. All petitions must meet the statutory requirements of G.S. 122C-261 and be reviewed for accuracy before submission.

Word Bank

Click a phrase to insert it at your cursor in the last focused text area.

Self-Care

Suicide

Harm to Others

Psychosis

Probability Language