COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGEJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)* IN THE MATTER OF:*CASE NO. **JOURNAL ENTRY * Respondent, alleged to be Mentally Ill.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .*THE PEOPLE OF THE STATE OF NEW YORK TOThis day of , 20 an application having been filed by , alleging that a patient hospitalized by Court Order at North Coast Behavioral Health Care Systems (NBHS) Toledo Campus, should be judicially determined to lack the capacity to give an informed, intelligent and knowing consent for medications, it is therefore ordered that be appointed to examine the Respondent and to report to the Court the findings as to the patient's capacity to give consent to medication and the appropriateness of the medication.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below) DateJudge Jack R. PuffenbergerAttorney(s) forOffice and P.O. Address«ni319mdO-Telephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:7/1/02FORM MH-208LC-JOURNAL ENTRY APPOINTING EXAMINER (MEDICATION)American LegalNet, Inc. www.USCourtForms.com