en-USComes the Respondent in the above-styled action and requests the Court to: en-US1. en-USen-US Stay en-USen-US Vacate en-USen-US Modify the Judgment and Order for Court-Ordered Assisted Outpatient Treatment entered onen-US, 2, as follows: en-USen-USen-US2. Respondent222s Address: , en-US3. Name and address of the outpatient provider agency where Respondent is receiving court-ordered assisted outpatient en-UStreatment:en-USen-US, en-US4. Facts and reasons supporting this request:en-USen-USen-USen-USWHEREFORE, the Respondent requests that this Court conduct a hearing in this matter. , 2 � Date � Signature of Respondent en-USAOC-737.6 Motion Type: MAOTen-USRev. 3-18en-USPage 1 of 2en-USCommonwealth of Kentuckyen-USCourt of Justice en-US www.courts.ky.goven-USKRS 202A.0825en-USMOTION TO STAY, VACATE, OR MODIFY en-USORDERen-US(COURT-ORDERED ASSISTED OUTPATIENT TREATMENT) lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. Court � County � Division � en-USDistricten-USIN THE INTEREST OF:en-USen-USen-USRespondenten-US* * * * * * * * * * * * � Address � City � State � County � Address � City � State � County en-USDateen-USNameen-USen-USName of Attorney (en-USplease print)en-USen-USSignature of Attorneyen-USen-USen-USAddress of Attorneyen-USen-USPhone Numberen-US( )en-USTo be completed if Respondent is represented by counsel: American LegalNet, Inc. www.FormsWorkFlow.com AOC-737.6Rev. 5-18Page 2 of 2HEARINGHearing scheduled for , 2 at a.m. p.m. at A copy of this Motion was mailed this date to the Respondent, the Respondent222s attorney of record, the Petitioner of record (see AOC-737), the county attorney, and outpatient provider agency. ClerkDate By: D.C.(Date)(Location)(Time) American LegalNet, Inc. www.FormsWorkFlow.com