Facsimile Transmittal Cover Sheet:
Petition For Medical Consent

Regarding:

(Patient Name) __________________________________________

Sender (Physician / Hospital)

From: _____________________________________________________, M.D.

Today's Date: _________ Time: _

Physician's Phone: _________ Physician's Pager: _ Physician's Cel: ______________

Fax Order to Physician at this number: ___________________________

To Special Justice of Richmond General District Court

Special Justice A. M. Baugh, FACSIMILE: 804-272-0903

Home Vox: 804-272-5711

Cel: 804-921-0611

Special Justice R. S. Majette, FACSIMILE: 804-747-9597 (H)

FACSIMILE: 804-780-1813 (O)

Home Vox: 804-273-9634

Cel: 804-690-8720

Fax to Judge On Call; see http://majette.net for schedule.