Mental Health Court Agreement - Conditions Of Treatement Form. This is a Washington form and can be use in King Local County.
Tags: Mental Health Court Agreement - Conditions Of Treatement, Washington Local County, King
King County District Court Mental Health Court Agreement / Conditions of Treatment Defendant Name: Date of Birth: Cause Number(s): Charge(s): Cause Number(s): Charge(s): Cause Number(s): Charge(s): Current Mental Health Treatment Provider: Current Case Manager: Date this form initially completed by court monitor___ Phone Number: date form updated (if different from initial date): DEFENDANT SHALL (please initial the conditions imposed by the Court): Comply with mental health treatment and attend all scheduled appointments, including appointments with all case managers, counselors, medicine prescribers, and groups recommended by the treatment provider. Take all prescribed medications, as recommended by a provider approved by Mental Health Court. Obtain a chemical dependency assessment within ___30___ days. Comply with treatment as recommended by a provider approved by Mental Health Court. This includes attending all scheduled appointments, selfhelp support groups, such as NA, AA, or CA, and submitting to urinalysis testing and Portable Breath Tests. (May be waived) Complete a certified Domestic Violence Treatment program, if ordered by the Court, with a provider approved by Mental Health Court. This includes attending all scheduled appointments, and completion of required assignments (May be waived) Sign all releases of information, as required, to monitor compliance listed in this Agreement / Conditions of Treatment and other conditions as ordered by Mental Health Court. ____ ____ ____ ____ ____ Report any change in address or telephone number to Probation within 24 hours. Mental Health Court referred and/or approved residence requires compliance with all rules and regulations of the residence, and notification to Probation prior to change of address. ____ Current Phone: ____ Comply with all the terms of the Judgment and Sentence or Order Deferring Sentence. ____ Do not use, possess or consume any alcohol or non-prescribed drugs. ____ Do not assault, threaten or harass any other person or damage or threaten any property. ____ Do not possess, own or have under your control any firearm or weapon. ____ Do not commit any new law violations. ______ ______ Current Address: Meet with Probation twice per month. This may be increased or decreased based upon need and compliance with the treatment plan. Attend regular review hearings with the court (usually every 30 days. If in compliance, every 60-90 days. ____ Other: ____ Other: Signature of Defendant: _____________________________________ Date: _____________________ Judge ______________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com