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JV-221Mandatory

Proof of Notice of Application

California · Judicial Council of California · Effective January 1, 2021

This form is used to prove to the court that all necessary people were given notice about an application for psychotropic medication. It asks the person filling it out to list who was notified and how they were notified.

The court describes it as: The person in charge of notice uses this to show the court that all parties with a right to receive notice were served a copy of the Application and attachments. A separate signature line is provided on each page of the form to accommodate those courts in which the provision of notice is shared between agencies.

Open the official PDFfrom Judicial Council of California

Where this fits in a case

Start a case

Stage: Start a case

This form is used in a juvenile case when someone needs to show the court that all required parties have been properly informed about an application for medication.

Either party may file.

Official instructions

How-to guides published by the court for this form.

Common questions

Who fills out this form?
The person in charge of notice uses this form to show the court that everyone who needed to be notified was served a copy of the Application and attachments.
Does this form require a fee?
The form text does not mention any filing fees.
What does this form prove?
It proves that specific parents, guardians, attorneys, and other parties were notified about a request to start or continue psychotropic medication.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2021.

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