Objection To Hospitalization Of Minor
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Objection To Hospitalization Of Minor Form. This is a Michigan form and can be use in Mental Health Statewide.
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Tags: Objection To Hospitalization Of Minor, PCM 202, Michigan Statewide, Mental Health
Approved, SCAO
JIS CODE: OBH
STATE OF MICHIGAN
PROBATE COURT
COUNTY
FILE NO.
OBJECTION TO HOSPITALIZATION
OF A MINOR
CIRCUIT COURT - FAMILY DIVISION
In the matter of
, a minor
1. I object to the hospitalization of this minor and request the court to schedule a hearing on this objection.
Date
Signature
1. The person filing this objection is
Name
and is
the minor patient, who is 14 years of age or older.
the minor's parent, guardian, or person in loco parentis. The request for hospitalization was made by the minor or
a peace officer.
a person designated by the court.
2. The minor is
years old and
was admitted
is scheduled for admission
to
upon the application of
Address
City
who is the minor's
State
Zip
Telephone no.
parent,
guardian,
person in loco parentis, i.e.
other, i.e.
3. The minor received a periodic review of his/her suitability for continued hospitalization on
Date
.
4. The reason for this objection is:
Do not write below this line - For court use only
PCM 202 (9/07)
OBJECTION TO HOSPITALIZATION OF A MINOR
MCL 330.1498m
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