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Here is the text we could read:

JV-222

Input on Application for
Psychotropic Medication

If you do not agree that the child should take the recommended psychotropic
medication and/or continue the psychotropic medication that the child is
currently taking, or if you wish to tell the court something about the child or
medication, complete this form and file it with the court within four court days
of receiving notice of the pending application for psychotropic medication.
Read form JV-217-INFO, Guide to Psychotropic Medication Forms, for more
information about the required forms and the application.

Clerk stamps date here when form is filed.

Child’s name:

Your name:

(first)

(middle)

(last)

Fill in court name and street address:

Superior Court of California, County of

(first)

(middle)

(last)

Your relationship to the child:

Attorney
CASA
Legal Guardian
Other (explain):

Caregiver
Indian Tribe
Parent

How long have you known the child?

(years)

(months)

(days)

Court fills in case number when form is filed.

Fill in child's name and date of birth:

Child's Name:

Date of Birth:

Case Number:

How long has the child lived in your home or facility?

(years)

(months)

(days)

The child does not live with me.

The application is opposed because:

Judicial Council of California, www.courts.ca.gov
Revised January 1, 2018, Optional Form
Welfare and Institutions Code, §§ 369.5, 739.5
California Rules of Court, rule 5.640

Input on Application for
Psychotropic Medication

JV-222, Page 1 of 2

Child’s name:

Case Number:

The application is not opposed, but I want to tell the court the following:

I am the attorney for the child.

a.
b.

I need more time to investigate the application.
I need the following information to determine whether to agree with or oppose the application:

There is other information the judge should know:

Additional information about the child for the court to consider is included on an attached sheet or sheets of
paper. (Write "Attachment 5" on top.)

Date:

Type or print name

Rev. January 1, 2018

Sign your name

Input on Application for
Psychotropic Medication

JV-222, Page 2 of 2

Input on Application for Psychotropic Medication

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 30
Average fields per page: 15
Reading Level: Grade 8
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

topmost_subform_page_item_tf__1 was topmostSubform[0].Page1[0].item5_tf[0] (0.60 conf)
topmost_subform_page_court_info_ft was topmostSubform[0].Page1[0].CourtInfo_ft[0] (0.40 conf)
topmost_page_case_number_ft__1 was topmostSubform[0].Page1[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page_childs_name_ft__1 was topmostSubform[0].Page1[0].ChildsName_ft[0] (0.42 conf)
topmost_page_date_field was topmostSubform[0].Page1[0].DateField1[0] (0.40 conf)
topmost_subform_page_childs_name_ft__2 was topmostSubform[0].Page1[0].ChildsName_ft[1] (0.42 conf)
topmost_subform_page_item_b_cb__1 was topmostSubform[0].Page1[0].item2b_cb[0] (0.40 conf)
topmost_subform_page_item_c_cb__1 was topmostSubform[0].Page1[0].item2c_cb[0] (0.40 conf)
topmost_subform_page_item_e_cb was topmostSubform[0].Page1[0].item2e_cb[0] (0.40 conf)
topmost_subform_page_item_tf__2 was topmostSubform[0].Page1[0].item3_tf[0] (0.40 conf)
topmost_subform_page_item_yourname_tf was topmostSubform[0].Page1[0].item1yourname_tf[0] (0.40 conf)
topmost_subform_page_item_g_cb was topmostSubform[0].Page1[0].item2g_cb[0] (0.33 conf)
topmost_subform_page_item_tf__3 was topmostSubform[0].Page1[0].item2other_tf[0] (0.40 conf)
topmost_subform_page_item_f_cb was topmostSubform[0].Page1[0].item2f_cb[0] (0.40 conf)
topmost_subform_page_item_tf__4 was topmostSubform[0].Page1[0].item3_tf[1] (0.40 conf)
topmost_subform_page_item_k_cb was topmostSubform[0].Page1[0].item5DK_cb[0] (0.38 conf)
topmost_subform_page_item_cb__1 was topmostSubform[0].Page1[0].item2d_cb[0] (0.40 conf)
topmost_subform_page_item_cb__2 was topmostSubform[0].Page1[0].item2a_cb[0] (0.40 conf)
topmost_subform_page_childs_name_ft__3 was topmostSubform[0].Page2[0].ChildsName_ft[0] (0.42 conf)
topmost_page_case_number_ft__2 was topmostSubform[0].Page2[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page_name_ft was topmostSubform[0].Page2[0].YourName_ft[0] (0.47 conf)
topmost_page_date_time_field was topmostSubform[0].Page2[0].DateTimeField1[0] (0.41 conf)
topmost_subform_page_item_tf__5 was topmostSubform[0].Page2[0].item6_tf[0] (0.40 conf)
topmost_subform_page_item_cb__3 was topmostSubform[0].Page2[0].item4_cb[0] (0.40 conf)
topmost_subform_page_item_cb__4 was topmostSubform[0].Page2[0].item4a_cb[0] (0.40 conf)
topmost_subform_page_item_b_cb__2 was topmostSubform[0].Page2[0].item4b_cb[0] (0.40 conf)
topmost_subform_page_item_b_tf was topmostSubform[0].Page2[0].item7b_tf[0] (0.40 conf)
topmost_subform_page_item_c_cb__2 was topmostSubform[0].Page2[0].item4c_cb[0] (0.40 conf)
topmost_subform_page_item_c_tf was topmostSubform[0].Page2[0].item7c_tf[0] (0.40 conf)
topmost_subform_page_item_cb__5 was topmostSubform[0].Page2[0].item5_cb[0] (0.40 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Input on Application for Psychotropic Medication

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02