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Order Of Detention Examination Evaluation Form. This is a Illinois form and can be use in Cook Local County.
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Tags: Order Of Detention Examination Evaluation, CCCO-0085, Illinois Local County, Cook
Order of Detention, Examination, Evaluation (This form replaces 85-MHDD-8)
(Rev. 7/6/01) CCCO 0085 A
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
COUNTY DEPARTMENT - COUNTY DIVISION
IN THE MATTER OF:
______________________________________________________________
}
No. _______________________________________
! Asserted to be a person subject to involuntary admission.
! Asserted to be mentally retarded and in need of judicial admission.
This matter coming to be heard on the Petition of ____________________________________________________ and the Court
having been fully advised:
The Court finds as follows:
! Subject person is in need of an examination.
! Subject person is in need of detention and examination.
IT IS ORDERED THAT ____________________________________________________________ submit to an examination by:
! a qualified examiner, ! clinical psychologist, ! a physician, or
! psychiatrist, within 24 hours of arrival at ____________________________________________________________________
(Name of hospital)
IT IS FURTHER ORDERED THAT:
! The respondent be allowed to remain in his/her place of residence until such time as he/she be examined.
! The peace officer of _______________________________________________________________________________________
(City, Village, County)
is commanded to take custody of: ___________________________________________________________________________
(Respondent’s name and address)
and IMMEDIATELY take him/her to:
________________________________________________________________________________________________________
(Name of local mental health facility)
________________________________________________________________________________________________________
(Address of local mental health facility)
for detention and examination pursuant to this Order of the Court. A qualified staff person is hereby appointed to examine
_____________________________________________________________ and report to this Court within 24 hours of admission.
! Clerk of the Court shall certify this Order of the Court.
Witness:
Entered: _____________________________________________
Judge
Judge’s No.
Date: ______________________________________, _________
Date: ____________________________________, _________
___________________________________________________
Clerk of Court
NOTICE: This Order is in effect for 72 hours. It expires _______________________________, _________ at ____________. m.
SEE BACK OF THIS FORM FOR RETURN
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
(Rev. 7/6/01) CCCO 0085 B
RETURN
On ______________________________, _________ at ______________. m., I took custody of
_________________________________________________ and brought him/her to ____________________
_____________________________________________________________________________ as commanded
_______________________________________, _________.
_________________________________________________
Signature
TO BE COMPLETED AT THE FACILITY ( if applicable)
On ______________________________, _________ at _____________. m., _______________
___________________________________________________________________ was received at this facility
together with his/her personal property.
Facility: ______________________________________________
Staff Signature: ______________________________________
Title: ________________________________________________
Facility Director: _____________________________________
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
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