Approved, SCAO JIS CODE: OHA FILE NO. STATE OF MICHIGAN PROBATE COURT COUNTY OF INITIAL ORDER FOLLOWING HEARING ON PETITION FOR ADMISSION In the matter of Court ORI Date of birth Place of birth Race Sex Current address of individual 1. Date of Hearing: Judge: Bar no. 2. A petition has been filed by asserting that the individual named Petitioner name (type or print) above is a person requiring treatment. 3. The court finds that notice of hearing has been given according to law. present in court. 4. The individual was not present for reasons stated on the record. The hearing was Present were: with without a jury. , attorney for the individual, and , attorney for the petitioner. 6. 5. Testimony of a physician or licensed psychologist was waived by the individual and the individual's attorney. Testimony was given by Testimony was not given because the parties stipulated to entry of the order. THE COURT FINDS: 7. By clear and convincing evidence, the individual is a person requiring treatment because the individual has a mental illness, and as a result of that mental illness a. can be reasonably expected within the near future to intentionally or unintentionally seriously physically injure self or others, and has engaged in an act or acts or made significant threats that are substantially supportive of the expectation. b. is unable to attend to those basic physical needs that must be attended to in order to avoid serious harm in the near future, and has demonstrated that inability by failing to attend to those basic physical needs. (Check item c. only if the proceeding originated as a petition directly to the court.) c. whose judgment is so impaired the individual is unable to understand the need for treatment. Continued behavior as the result of this mental illness can be reasonably expected, on the basis of competent clinical opinion, to result in significant physical harm to self or others. 8. There is is not an available treatment program that is an alternative to hospitalization or that follows an initial period of hospitalization adequate to meet the individual's treatment needs and is sufficient to prevent harm that the individual may inflict upon self or others within the near future. 9. hospital can provide treatment which is adequate and appropriate to the individual's condition. (SEE SECOND PAGE) Do not write below this line - For court use only American LegalNet, Inc. www.FormsWorkFlow.com PCM 214 (9/14) INITIAL ORDER FOLLOWING HEARING ON PETITION FOR ADMISSION MCL 330.1401, MCL 330.1468, MCL 330.1469a, MCL 330.1470, MCL 330.1472a, MCL 330.1475 10. 11. The individual is not a person requiring treatment. The individual has been hospitalized involuntarily two or more times within the two-year period immediately preceding the filing of the petition and has rejected aftercare programs and treatment. IT IS ORDERED: 12. The individual be hospitalized in the previously mentioned hospital for a period not to exceed 60 days. 13. The individual undergo combined hospitalization and alternative treatment for a period not to exceed 90 days. Hospitalization in the hospital stated in item 9 shall not exceed 60 days. Alternative treatment shall be under the supervision of a community mental health services program a mental health agency or professsional as follows: 14. 15. An initial hospitalization period shall not exceed days. The individual is discharged from the hospital and shall undergo an alternative treatment program under the supervision of a community mental health services program a mental health agency or professional for a period not to exceed 90 days as follows: The individual receive assisted outpatient treatment through Community mental health services program or other publicly-funded entity for a period not to exceed 180 days. Case management services shall be as follows: Additionally, one or more of the following is ordered: 16. (see MCL 330.1469a[3] for specific provisions that may be ordered) The individual undergo combined hospitalization and assisted outpatient treatment for a period not to exceed 180 days. Hospitalization in the hospital stated in item 9 shall not exceed 60 days. Assisted outpatient treatment shall be under the supervision of Name of local community mental health services program or other publicly-funded entity as follows: An initial hospitalization period shall not exceed days. If the individual refuses to comply with a psychiatrist's order to return to the hospital, a peace officer shall take the individual into protective custody and transport the individual to the hospital designated by the psychiatrist. 18. Unless the petition is denied, dismissed, or withdrawn, the Michigan Department of State Police shall immediately enter the individual's identifying information in this court order on the law enforcement information network. 19. Is discharged and the petition is denied on the merits. dismissed/withdrawn. 20. If felony charges have been previously dismissed under MCL 330.2044(1)(b) and the time for petitioning to refile charges has not elapsed: a. not less than 30 days before the scheduled release or discharge, the director of the treating facility shall notify the prosecutor's office in the county in which charges against the person were originally brought that the patient's release or discharge is pending. b. not less than 30 days before the scheduled release or discharge, the patient to be released or discharged shall undergo a competency examination as described in MCL 330.2026. A copy of the written report of the examination along with the notice required in item 20.a. above shall be submitted to the prosecutor's office in the county in which the charges against the patient were originally brought. The written report is admissible as provided in MCL 330.2030(3). 17. Date Judge American LegalNet, Inc. www.FormsWorkFlow.com