STATE OF NORTH CAROLINA County Name Of Respondent File No. In The General Court Of Justice District Court Division IN THE MATTER OF: INVOLUNTARY COMMITMENT ORDER MENTALLY ILL G.S. 122C-267, 122C-268, 122C-271, 122C-276 FINDINGS The Court finds that: 1. The State 2. The respondent 3. The 24-hour facility was was was was not represented by counsel. was not represented by counsel. was not represented by counsel. Based on the evidence presented, the Court 4. by clear, cogent and convincing evidence finds as facts all matters set out in the physician's/eligible psychologist's report, specified below, and the report is incorporated by reference as findings. Date Of Last Examiner's Report Name Of Physician/Eligible Psychologist 5. by clear, cogent and convincing evidence finds these other facts: respondent discharged before court date respondent signed voluntary commitment before court date special counsel stipulates there is sufficient evidence for commitment facts supporting involuntary commitment: 6. finds that the respondent does not meet the criteria for commitment. 7. finds that this proceeding was begun after the respondent was charged with a violent crime and was found incapable of proceeding. NOTE: Use AOC-SP-911M for involuntary commitment of defendant found not guilty by reason of insanity. NOTE TO CLERK: The clerk in the hearing county should enter this order into NICS, if appropriate, and forward the original order to the clerk in the originating county. (Over) AOC-SP-203, Rev. 7/11 © 2011 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com CONCLUSIONS Based on the above findings, the Court concludes that the respondent: 1. 2. 3. 4. 5. 6. is mentally ill. is not mentally ill. in addition to being mentally ill, is mentally retarded. is dangerous to self others. is not dangerous to self or others. (only for nondangerous mentally ill) is capable of surviving safely in the community with available supervision from family, friends or others; and based on respondent's psychiatric history, the respondent is in need of treatment in order to prevent further disability and deterioration which would predictably result in dangerousness to self or others. And, that the respondent's inability to make an informed decision to voluntarily seek and comply with recommended treatment is caused by: the respondent's current mental status. the nature of the respondent's mental illness. ORDER It is ORDERED that: 1. the respondent be committed/recommitted to the inpatient 24-hour facility named below for the period specified. 2. the respondent be committed/recommitted to outpatient commitment under the supervision and management of the center/physician named below for the period specified. the respondent may be held at the 24-hour facility where he/she is now being held, for up to 72 hours in order for the facility to notify the designated outpatient center of respondent's treatment needs. 3. the respondent be committed/recommitted to an inpatient 24-hour facility named below not to exceed the specified period. Following discharge from the 24-hour facility, the respondent shall be committed to outpatient commitment under the supervision of the center/physician named below for the specified period. 4. the respondent be discharged and this matter dismissed. 5. this matter be dismissed. 6. the respondent be discharged. Since the respondent was charged with a violent crime and previously found incapable of proceeding, it is further ordered that the respondent be released to the custody of the law enforcement agency named below. Name Of Law Enforcement Agency 7. this matter be transferred to the county named below for further proceedings. County INPATIENT COMMITMENT Committed/recommitted to inpatient facility for a period not to exceed days. 180 days. Name And Address Of 24-Hour Facility OUTPATIENT COMMITMENT Committed/recommitted to outpatient facility for a period not to exceed days. 90 days. 180 days. 90 days. 1 year. Name And Address Of Treatment Center/Physician Date Signature Of District Court Judge Name Of District Court Judge (Type Or Print) AOC-SP-203, Side Two, Rev. 7/11 © 2011 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com