B. The application for evaluation shall include the following, if known:

1. 1. The name and address of the proposed patient for whom evaluation is applied.
2. 2. The age, date of birth, sex, race, marital status, occupation, social security number, present location, dates and places of previous hospitalizations, names and addresses of the guardian, agent under a health care power of attorney or mental health care power of attorney, spouse, next of kin and significant other persons and other data that the director may require on the form to whatever extent that this data is known and is applicable to the proposed patient.
3. 3. The name, address and relationship of the person who is applying for the evaluation.
4. 4. A statement that the proposed patient is exhibiting behaviors that may be consistent with a mental disorder and is believed to be, as a result of a mental disorder, a danger to self or to others or a patient with a persistent or acute disability or a grave disability and the facts on which this statement is based.
5. 5. A statement from the applicant of whether the applicant believes that the proposed patient is or is not willing or able to undergo voluntary evaluation and the facts on which this statement is based.
6. 6. A statement of the proposed patient's relevant history of mental health diagnosis, treatment recommended or provided and compliance with the treatment recommended or provided.
7. 7. A statement that the applicant believes the proposed patient is in need of screening, evaluation, supervision, care and treatment and the facts on which this statement is based.
8. 8. Copies of all documents relating to guardianship or powers of attorney that allow the guardian or agent to consent to inpatient psychiatric treatment, which shall be attached to the application if available at the time of the application.
9. 9. A statement by the applicant of whether the applicant believes that, without a period of inpatient observation, stabilization and assessment or emergency inpatient psychiatric hospitalization, the proposed patient is likely to cause or endure serious physical harm or injury and the facts supporting that statement.
10. 10. To the extent known, the names and contact information of persons other than the applicant who have witnessed the behavior exhibited by the proposed patient on which the application is based. The screening agency may not deny or refuse to process an application because no other witnesses have been identified.

J. If the screening agency determines that the application should be denied or if the application is accepted but the screening agency declines to file a petition for court-ordered evaluation, the screening agency shall comply with the requirements of section 36-521, subsection C. If the screening of the proposed patient took place in a facility operated by the screening agency, the screening agency shall attempt to notify the applicant that the screening agency intends to release the proposed patient. The screening agency shall document the time and method of the notification or an unsuccessful attempt to notify the applicant. If requested by the applicant, the medical director of the screening agency or the medical director's designee shall provide the reason for the denial of the application or the decision not to file a petition for court-ordered evaluation if either:

1. 1. The disclosure is not opposed by the person who was screened.
2. 2. The person who was screened is deemed to lack capacity to make the decision to allow the disclosure and the disclosure is deemed to be in the person's best interest.

K. For the purposes of this section, "person" includes a person who:

1. 1. Is under eighteen years of age.
2. 2. Has been transferred to the criminal division of the superior court pursuant to section 8-327 or who has been charged with an offense pursuant to section 13-501.
3. 3. Is under the supervision of an adult probation department.