In the matter of First, middle, and last name � DOB: � STATE OF MICHIGANPROBATE COURTCOUNTY OF PETITION FOR SECOND � CONTINUINGMENTAL HEALTH TREATMENT ORDERFILE NO. en-US1. I, en-USName (type or print)en-US, state that I am � � the authorized representative of the agency or mental health professional supervising the individual222s assisted � outpatient treatment program. � � � en-USDirector or authorized representativeen-US of en-USName of hospital . � � � 2. � The individual is currently � � residing � � hospitalized � at en-USAddress and telephone no.en-US � � en-US . � � � 3. � The � � initial � � second � � continuing � order entered by this court for the individual expires on en-USDateen-US . 4. � The individual continues to be a person requiring treatment and is in need of � � hospitalization for not more than 90 days. � � continuing hospitalization for a period of one year. � � combined hospitalization and assisted outpatient treatment for not more than one year. � � assisted outpatient treatment for not more than one year. 5. � The individual is likely to refuse treatment on a voluntary basis when the order expires. en-USINSTRUCTIONS: In answering items 6 and 7, include a description of the observed or reported behavior of the individual en-USincluding, but not limited to, how behavior and conditions have changed since the last order and whether any stabilization or en-USremission is contingent on continued medication or other treatment. Avoid medical terms and conclusions other than diagnosis. 6. � The basis for this allegation is that I believe the individual has a mental illness and: en-US(Check all that apply.) � � a. � as a result of that mental illness, the individual can reasonably be expected within the near future to intentionally or � � � � � � � � � � � � � � � � � � � that are substantially supportive of this expectation. � b. � as a result of that mental illness, the individual 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. � c. � the individual222s judgment is so impaired by that mental illness and whose lack of understanding of the need for � treatment has caused him or her to demonstrate an unwillingness to voluntarily participate in or adhere to � treatment that is necessary, on the basis of competent clinical opinion, to prevent a relapse or harmful deterioration � � � � � � � � � � � � � � � � � � � � 7. � This conclusion is based upon � a. my personal observation of the person doing the following acts and saying the following things: � � en-US � en-US � � American LegalNet, Inc. www.FormsWorkFlow.com File No. � b. the following conduct and statements that others have seen or heard and have told me about: � � en-US � � en-US � � by: Witness name � Complete address � � Telephone no. 8. � The diagnoses of physical and mental conditions are en-US � en-US en-US . � 9. � The treatment program(s) provided to the individual thus far, and the results, are en-US � � en-US � en-US � en-US en-US . � 10. � The present treatment � � is � � is not � adequate and appropriate to the individual's condition. � The individual � � is � � is not � motivated to participate in this treatment program. The estimate of further time necessary � � to provide the required treatment is en-US en-US . � � � � � � � � � � � � � � � � � � � en-US � � en-US 11. � The interested parties, their addresses, and their representatives are identical to those appearing on the initial petition � except as follows: � � � � � � � � 13. � en-USI REQUESTen-US the court to order the individual to receive � � hospitalization for not more than 90 days. � � continuing hospitalization for not more than one year. � � combined hospitalization and assisted outpatient treatment for not more than � 90 days � en-US one year. � � assisted outpatient treatment for not more than � 90 days � en-US one year.en-USI declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of en-USmy information, knowledge, and belief. en-USDate � en-USSignature of petitioner � � en-USAddress � � City, state, zip� Telephone no. American LegalNet, Inc. www.FormsWorkFlow.com