STATE OF NORTH CAROLINA County IN THE MATTER OF: Name And Address Of Respondent File No. In The General Court Of Justice District Court Division ORDER VOLUNTARY ADMISSION OF MINOR G.S. 122C-224, -224.3 FINDINGS The Court finds that: 1. The respondent is a minor. 2. The respondent is represented by the attorney named below: Name Of Attorney 3. The respondent is present at the hearing. 4. The respondent appears before the Court to provide testimony and to answer the Court's questions; otherwise, respondent's appearance is waived. 5. The respondent's appearance is waived. 6. The respondent was voluntarily admitted to the 24-hour facility named below on the date specified. Name Of Facility Date Of Admission 7. The Court previously concurred in the admission, and the matter before the Court is the readmission of the respondent. Based on the evidence presented, the Court 8. by clear, cogent and convincing evidence finds as facts all matters set out in the evaluation for admission/continued stay of the physician or other professional specified below, and the report is incorporated by reference as findings. Date Of Report Name Of Physician/Professional 9. by clear, cogent and convincing evidence finds these other facts: AOC-SP-913M, Rev. 7/11 © 2010 Administrative Office of the Courts (Over) CONCLUSIONS Based on the above findings, the Court concludes that 1. the respondent is is not mentally ill. is is not a substance abuser. is is not in need of continued treatment at the 24-hour facility to which the respondent has been admitted. 2. less restrictive measures would not be sufficient. 3. reasonable grounds exist to believe that the respondent is mentally ill a substance abuser and is in need of treatment at the 24-hour facility to which the respondent has been admitted but additional diagnosis and evaluation is needed before the court can concur in the admission. 4. the respondent does not meet the criteria for admission. ORDER 1. The Court concurs with the voluntary admission and authorizes the continued admission of the respondent for the length of time specified below. Length Of Admission days 2. The Court authorizes an additional stay for the length of time specified below for further diagnosis and evaluation and ORDERS this matter rescheduled for further hearing at the date, time and place specified below: Length Of Additional Stay days (cannot exceed 15) Date Of Hearing Place Of Hearing Time Of Hearing AM PM 3. The Court does not concur in the voluntary admission and the respondent is ordered released. 4. Other: Date Name Of District Court Judge (Type Or Print) Signature Of District Court Judge NOTE: "Upon the request of the legally responsible person or the minor admitted or committed, and after that minor has both been released and reached adulthood, the court records of that minor made in proceedings pursuant to Article 5 of [Chapter 122C] may be expunged from the files of the court." G.S. 122C-54(e) AOC-SP-913M, Side Two, Rev. 7/11 © 2011 Administrative Office of the Courts