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� en-USen-USen-US(Check appropriate box)en-USen-US A en-USphysicianen-USen-USen-USen-US A en-USpsychiatristen-USen-USen-USen-USen-US A en-USpsychologisten-USen-USpsychological practitioneren-USen-USen-USen-USpsychological associateen-USen-USen-USen-US A en-USen-USen-USen-USen-USen-USen-USen-USen-US A en-USen-USen-USen-USen-USen-USen-USen-USen-USen-US A en-USen-USen-USen-USen-USen-USen-US A en-USen-USen-USen-USen-USen-USen-US A en-USphysician assistant en-USen-USen-USen-US en-USen-USen-US en-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-US en-USen-USen-USen-USen-USen-US www.courts.ky.goven-USen-USEXAMINATION CERTIFICATIONen-USFOR COURT-ORDEREDen-USASSISTED OUTPATIENT TREATMENT lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE � � � en-USen-USen-USen-USen-USen-USen-USen-US* * * * * * * * * * * *en-US American LegalNet, Inc. www.FormsWorkFlow.com en-USen-USen-US � en-USen-USen-USen-US(check one)en-USen-USen-US(Complete only paragraph 3)en-USORen-USen-USen-USen-USen-USen-USen-US(Complete paragraphs 1 through 3) en-USen-US(state reason(s) and attach supporting documentation)en-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-USen-US � � en-USSubmit this form immediately if possible but in any event, no later than seventy-two (72) hours following the examination en-US(excluding weekends and holidays).en-USReminder: If court-ordered assisted outpatient treatment is recommended, you must provide a proposed written treatment plan no lateren-US en-USthan the date of the hearing. KRS 202A.0817.en-USen-US � � � � American LegalNet, Inc. www.FormsWorkFlow.com
