In the matter of First, middle, and last name 1. � Date of hearing en-US(if one)en-US: en-US � Judge: � Bar no. 2. � This court issued an � � initial � � second � � continuing � order on en-USDateen-US directing the individual � named above to undergo a program of assisted outpatient treatment or combined hospitalization and assisted � outpatient treatment. � � � � � � � the individual is not complying with the order for assisted outpatient treatment or combined hospitalization and assisted � outpatient treatment. � � � � � � � � � � � � � � � � � � � � � self or others. � � the individual believes that the assisted outpatient treatment program is not appropriate. 4. � en-USTHE COURT FINDS: � en-US � en-US � en-US en-USIT IS ORDERED: � � � � � � � � � � � � � � � � � � � the individual shall undergo a program of assisted outpatient treatment under the supervision of � en-US en-US a community mental health services program � en-US en-US en-US a mental health agency or professional � as follows: en-US en-US en-US � en-US � This assisted outpatient treatment shall not exceed the time from the date of issuance of the � en-US initial � second � continuing � combined order. � � � � � � � � � � � � � � � � � � � the individual shall be hospitalized at en-US � for a period not to exceed the remainder of the previously-ordered hospitalization portion of the � initial � second � continuing � combined order. American LegalNet, Inc. www.FormsWorkFlow.com File No. � � � � � � � � � � � � � � � � � the individual shall continue to undergo combined hospitalization and assisted outpatient treatment for the remainder of � the previously-ordered period. The individual shall be hospitalized at en-US � for a period not to exceed the remainder of the initially ordered hospitalization portion of the � � initial � � second � continuing � combined order. Assisted outpatient treatment shall be under the supervision of � en-US en-US a community mental health services program � en-US en-US en-US a mental health agency or professional � as follows: en-US en-US en-US � en-US � en-USNOTICE: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � individual into protective custody and transport the individual to the hospital designated by the psychiatrist. � � 9. � This order expires on en-USDateen-US . en-USDate � en-USJudgeen-USIf the court has ordered you to be hospitalized rather than continue in an assisted outpatient treatment program you have a right en-USto object to this hospitalization. If you wish to object, complete the objection below and send a copy to the court. en-USI certify that this notice was personally served on the individual named above on en-USDateen-US at en-USTimeen-US en-USand a copy was mailed to the en-US en-US Court on en-USDateen-US . � en-USSignatureen-USI object to my hospitalization and request that the court schedule a hearing on the objection. en-USDate � en-USSignatureen-USNOTICE OF RIGHT TO OBJECT TO HOSPITALIZATION en-USPROOF OF SERVICE en-USOBJECTION TO HOSPITALIZATION American LegalNet, Inc. www.FormsWorkFlow.com