PC-MI-50.5 (Rev. 4/2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE IN THE MATTER OF CASE NO. ENTRY AUTHORIZING MEDICATION OR MEDICAL PROCEDURE [R.C. 2101.24 and R.C 5122.271] Upon application and for good cause shown, the following procedure: IS HEREBY ORDERED to be performed upon and the Court further finds: (1) is unable to receive the information required to give a fully informed intelligent and knowing consent; (2) that and have recommended to the Court that the above described procedure take place; (3) that the Court has notified the Legal Rights Service of this application to Authorize; (4) Upon examination of all evidence, the Court hereby finds that the above procedure as applied for is necessary. The Court hereby authorizes the same to be performed. Date: LAWRENCE A. BELSKIS Judge APPROVED: FRANKLIN COUNTY FORM - 50.5 ENTRY AUTHORIZING MEDICATION OR MEDICAL PROCEDURE 2002 © American LegalNet, Inc.