Order For Substance Abuse Evaluation
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Order For Substance Abuse Evaluation Form. This is a Michigan form and can be use in Motor Vehicle Offenses Statewide.
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Tags: Order For Substance Abuse Evaluation, MC 211, Michigan Statewide, Motor Vehicle Offenses
2nd copy - Probation officer
3rd copy - Defendant
Original - Court
1st copy - Agency
Approved, SCAO
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
CASE NO.
ORDER FOR
SUBSTANCE ABUSE EVALUATION
Court address
Court telephone no.
Defendant's name, address, and telephone no.
The State of Michigan
THE PEOPLE OF
v
The defendant in this case was convicted of an alcohol/controlled substance offense.
On the date of the arrest,
, the defendant's breath-alcohol content was
.
Date
IT IS ORDERED:
1. The defendant, at his/her own cost, shall have a substance abuse screening and assessment by
Agency name and address
to determine whether the defendant will benefit from rehabilitative services. The agency shall submit a written report to the court
by
.
Date
2. If the defendant is on bond, he/she shall report to the named agency for evaluation by
.
Date
If the defendant fails to report by the above date for evaluation, the court may issue a bench warrant for his/her arrest.
3. Failure to appear for the evaluation may result in sentencing without the benefit of the evaluation.
4. If the defendant is in jail, the evaluation shall be performed either at the jail or at the named agency.
Date
Judge/Magistrate
ACKNOWLEDGMENT OF SERVICE
I acknowledge that I have received a copy of this order for evaluation on
.
Date
Defendant
NOTICE OF MAILING BY COURT
A copy of this order was mailed to/personally served on the named agency on
.
Date
Date
MC 211 (3/08)
Signature and title
ORDER FOR SUBSTANCE ABUSE EVALUATION
MCL 257.624a(3), MCL 257.624b(1), MCL 257.625b(5),
MCL 333.7408a(3), MCL 436.1703(1)(a)
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