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