(Name of the Facility)______________________________day of ____________________19___
I, ______________________________ (member of the CTF staff) have today received a request for the release of ____________________ (name of child) from the undersigned child on his or her own behalf or from the undersigned person on behalf of the child.
__________________________________________________
Signature or mark of child making request for release.
__________________________________________________
Signature or mark of person making request for release on behalf of patient.
__________________________________________________
Signature or mark of staff person receiving request for release
Cal. Code Regs. Tit. 9, § 1926
2. Governor Newsom issued Executive Order N-55-20 (2019 CA EO 55-20), dated April 22, 2020, which suspended certain provisions related the operation of treatment and rehabilitation facilities that could restrict staffing flexibility, due to the COVID-19 pandemic.
Note: Authority cited: Section 4094, Welfare and Institutions Code. Reference: Sections 4094 et seq., Welfare and Institutions Code; and Section 1502, Health and Safety Code.