(3) The name and residence of the respondent's parents,
if living and if known, or of the respondent's legal
guardian, if any and if known.
(4) The name and residence of the respondent's spouse,
if any and if known.
(5) The name and residence of the individual having
custody of the respondent, if any, or if no such individual
is known, the name and residence of a near relative or a
statement that the individual is unknown.
(6) The petitioner's belief, including the factual basis
for the belief, that the respondent is suffering from alcohol
and other drug abuse and presents an imminent danger or
imminent threat of danger to self, family or others if not
treated for alcohol or other drug abuse.
(c) Certificate and statement.--The following shall apply:
(1) Any petition filed under this act shall be
accompanied by a certificate of a physician who has examined
the respondent within two days prior to the day that the
petition is filed in the court of common pleas. The physician
shall be authorized to practice medicine and surgery or
osteopathic medicine and surgery under the act of December
20, 1985 (P.L.457, No.112), known as the Medical Practice Act
of 1985, or the act of October 5, 1978 (P.L.1109, No.261),
known as the Osteopathic Medical Practice Act. The
physician's certificate shall set forth the physician's
findings in support of the need to treat the respondent for
alcohol and other drug abuse. The certificate shall indicate
if the respondent presents an imminent danger or imminent
threat of danger to self, family or others if not treated.
Further, the certificate shall indicate the type and length
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