Order Following Notice Of Noncompliance Wtih Assisted Outpatient Treatment
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Order Following Notice Of Noncompliance Wtih Assisted Outpatient Treatment Form. This is a Michigan form and can be use in Mental Health Statewide.
Loading PDF...
Tags: Order Following Notice Of Noncompliance Wtih Assisted Outpatient Treatment, PCM 244, Michigan Statewide, Mental Health
Approved, SCAO
JIS CODE: OFN
STATE OF MICHIGAN
ORDER FOLLOWING NOTICE OF NONCOMPLIANCE
WITH ASSISTED OUTPATIENT TREATMENT OR
PROBATE COURT
COMBINED HOSPITALIZATION AND ASSISTED
COUNTY
CIRCUIT COURT - FAMILY DIVISION
FILE NO.
OUTPATIENT TREATMENT ORDER
In the matter of
1. Date of hearing (if one):
Judge:
Bar no.
2. This court issued an order on
directing the individual named above to undergo a program of
Date
assisted outpatient treatment or combined hospitalization and assisted outpatient treatment.
3. The court has been notified that the individual is not complying with the order for assisted outpatient treatment or combined
hospitalization and assisted outpatient treatment.
4. THE COURT FINDS:
IT IS ORDERED:
5. A peace officer shall take the individual into protective custody and transport the individual to
the preadmission screening unit established by the community mental health services program serving the community in
which the individual resides.
.
Designated facility
6. The individual shall be hospitalized at
for a period of not more than 10 days. If necessary, a peace officer shall take the individual into protective custody.
as recommended by the community mental health services program, more than 10 days but not more than the duration
of the order for assisted outpatient treatment or 90 days, whichever is less. If necessary, a peace officer shall take the
individual into protective custody.
7. The individual may return to assisted outpatient treatment before the expiration of the prior order of assisted outpatient
treatment or combined hospitalization and assisted outpatient treatment as follows:
Judge
Date
NOTICE OF RIGHT TO OBJECT TO HOSPITALIZATION
This court has ordered you to be hospitalized. You have a right to object to this hospitalization. If you wish to object, complete
the objection below and send a copy to the court.
PROOF OF SERVICE
I certify that this notice was personally served on the above individual on
at
Date
and a copy mailed to the
Time
Court on
.
Date
Signature
OBJECTION TO HOSPITALIZATION
I object to my hospitalization and request that the court schedule a hearing on the objection.
Date
Signature
Do not write below this line - For court use only
MCL 330.1475(3), (4), (5), (6), MCR 5.744
PCM 244 (9/07) ORDER FOLLOWING NOTICE OF NONCOMPLIANCE WITH ASSISTED OUTPATIENT TREATMENT OR
COMBINED HOSPITALIZATION AND ASSISTED OUTPATIENT TREATMENT ORDER
American LegalNet, Inc.
www.FormsWorkflow.com
