Order For Placement Of Individual With Developmental Disability
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Order For Placement Of Individual With Developmental Disability Form. This is a Michigan form and can be use in Probate Statewide.
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Tags: Order For Placement Of Individual With Developmental Disability, PC 665, Michigan Statewide, Probate
Approved, SCAO
JIS CODE: OPI
STATE OF MICHIGAN
PROBATE COURT
COUNTY
CIRCUIT COURT - FAMILY DIVISION
FILE NO.
ORDER FOR PLACEMENT OF
INDIVIDUAL WITH
DEVELOPMENTAL DISABILITY
, an individual with a developmental disability
In the matter of
1. Date of hearing:
Judge:
Bar no.
2. The guardian has filed a petition requesting authority to execute an application for admission of the individual to a facility.
THE COURT FINDS:
3. Notice of hearing was given to or waived by all interested persons.
4.
is the guardian of the person for the individual named above.
Name
5. From testimony given in open court and from the report and evaluation filed with the court, the individual requires care and
services at
.
Name of facility
6. The placement offers appropriate treatment and residential programs to meet the individual's need.
7. There appears to be no less restrictive treatment and residential program available to meet the individual's needs.
IT IS ORDERED:
8. The guardian is authorized to execute the necessary application for the
temporary administrative admission not to exceed 30 days
administrative admission
admission
of the individual named above to
.
Name of facility
Date
Judge
Do not write below this line - For court use only
PC 665 (9/07)
ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY
MCL 330.1623, MCR 5.746(B)
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