INSTRUCTIONS FOR EVALUATION FACILITY: This form shall be filed with the court immediately MC-410 (8/18)(cs) AS 47.30.720; AS 47.30.725(b); NOTICE OF RELEASE AS 47.30.780 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity ) for the Hospitalization of: ) ) , ) Case No. Respondent. ) Date of Birth: ) ) NOTICE OF RELEASE To: Superior Court at , Alaska. The court ordered that the respondent be hospitalized for evaluation at one of the facilities below. Pursuant to that order, the respondent was delivered to the following facility on : Alaska Psychiatric Institute PeaceHealth Ketchikan Medical Center Bartlett Regional Hospital Yukon-Kuskokwim Delta Reg. Hospital Fairbanks Memorial Hospital Other The above facility released the respondent on , at am pm. Reason for Release: Qualified personnel at the above facility determined that the respondent no longer meets the criteria for hospitalization or commitment. The court denied the 30/90/180-day petition for commitment in this case. Date Signature Print Name and Title Phone Number E-mail address I certify that on , a copy of this notice was provided to: respondent parent/guardian PDA AGO By Clerk: American LegalNet, Inc. www.FormsWorkFlow.com