资源描述：
《VOLUNTARYTREATMENTAGREEMENT(Sample)自愿治疗协议样本.doc》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。
1、VOLUNTARYTREATMENTAGREEMENT(Sample)ThisisabindinglegalagreementbetweentheNorthDakotaDepartmentofHumanServices(NDDHS),byandthroughitsDivisionofMentalHealthandSubstanceAbuse(DMHSA),andthelegalcustodianorguardianofthefollowingchild.Thesolereasonfortheplacementistheneedtoobtainservicesfor
2、thechild'semotionalorbehavioralissues.Allothercommunityresourceshavebeenexhausted.Withinthecontextofthisagreement,thefollowingdefinitionsapply:1・”Fullauthorityforthechild'splacementandcare"meansthatapartyhascompletecontroloverachild'scareandservices.2."Legalcustody"meansthepartytowhom
3、acourtorderhasgivencustodyorthechild'sparentswhennolegalactionhasremovedlegalcustody.3."Physicalcustodyandcontrol”meansthatthechild'sphysicalbodyisunderthecare,custody,andcontrolofapartyotherthanthepartywithlegalcustody.Child'sName(First,Middle,Last)DateofBirthSocialSecurityNumberLega
4、lCustodianorGuardianAgrees:Iamthelegalparent,custodian,orguardianoftheabove-namedchildandvoluntarilyagreetoplacethechildwiththeNDDHSDMHSA.Bythisagreement,Iamdelegatingcertainrightsandduties.IagreethatDMHSAwillhavefullauthorityforthechild'splacementandcareasitdeemsnecessaryforthechild'
5、ssafety,discipline,training,growthanddevelopment,andanyspecialservices,includingtreatment,whichthechildmayrequire・IunderstandthatIretaintheauthorityasthelegalguardianoftheabove-namedchildandassuchIamobligatedtocontinuetoexerciseandperformallmyparentaldutiesandlegalresponsibilitiesexce
6、ptthosespecificallygrantedtoDMHSAbythisagreement.Inordertofulfillmyresponsibilitiestomychild:1.TograntDMHSAfulllegalauthorityandresponsibilityforthecareofmychild:2.TodelegatetoDMHMAthefollowingdutiesandresponsibilities:a.Tohavephysicalcustodyandcontrolofmychild;b.Tosupplymychildwithfo
7、od,clothing,shelter,andincidentalnecessities;c.Toprovidemychildwithcare,education,anddiscipline;andd.Toauthorizeordinarymedical,dental,psychiatric,psychological,hygieneorotherremedialcareandtreatmentformychildifreasonableeffortstoconsuitwithmehasbeenunsuccessful.Also,toauthorizesurger
8、yorot
