(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 the individual is
not 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 and other drug abuse.
(c) Certificate and statement.--The following shall apply:
(1) A 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 of treatment
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