DC-64 (revised September 2018) STATE OF RHODE ISLAND ANDPROVIDENCE PLANTATIONS DISTRICT COURT ORDER FOR HOSPITALIZATION IN A MENTAL HEALTH FACILITY Sixth Division Fourth Division Third Division Second Division Person Certified Represented By Attorney Mental Health Advocate Notice having been duly and seasonably given according to law to the above-named person and to other interested persons as ordered by the court, and a full hearing having been had on the issues involved herein, at which the above-named person was represented as indicated above, and full consideration having been given to the evidence presented at the hearing, THE COURT FINDS BY CLEAR AND CONVINCING EVIDENCE: That the above-named person is in need of care and treatment in a facility and is one whose continued unsupervised presence in the community would by reason of mental disability create a likelihood of serious harm and that all alternatives to certification have been investigated and deemed unsuitable. NOW, THEREFORE, IT IS HEREBY ORDERED: That the above-named person be hospitalized at the: Eleanor Slater Hospital Butler Hospital IT IS FURTHER ORDERED: That the Director of the Institution indicated above receive and detain the above-namedperson for hospitalization in accordance with the law. Entered as an Order of the court on . ENTER: /s/ Judicial Officer American LegalNet, Inc. www.FormsWorkFlow.com