IN THE CIRCUIT COURT OF __________________ COUNTY, WEST VIRGINIA IN RE: Involuntary Hospitalization of Case No. ________- MH -________ ___________________________________ RESPONDENT NOTICE OF FINAL COMMITMENT HEARING [W.Va. Code: §27-5- 4 and 27-4-3(c)] Pursuant to the provisions of West Virginia Code: §§27-5-4 and/or 27-4-3(c), ___________________________________, has filed with this Court an application seeking final commitment proceedings for the involuntary hospitalization of the Respondent. The Application has been reviewed by __________________________________________, Mental Hygiene Commissioner / Judge of the Circuit Court of ________________________ County, West Virginia, who has concluded the application sets forth information sufficient to warrant a hearing on the issue of whether the Respondent should be hospitalized involuntarily for the care and treatment of [initial appropriate items(s)] ______ addiction and/or ______mental illness. The specific allegations against the Respondent and the facts underlying and supporting the application pursuant to West Virginia Code: §27-5-4(e), are as follows: ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ _______________________________________________________________________________________ Accordingly, this hearing will be held on __________________, the ______ day of _______________, 20____, at the hour of ______________M., at [location] _________________________________________________________________________ ___________________________________________________________________ or as soon thereafter as counsel may be heard. At this hearing, the Mental Hygiene Commissioner or Judge will determine whether the Respondent should be involuntarily hospitalized. ____________________________________________________ has been appointed to represent the Respondent. (attorney’s name) _______________________________________________________________________________________________ (attorney’s address and telephone number) In this matter, the law guarantees the Respondent certain rights, including the right to have counsel appointed in the event the Respondent has not retained counsel and to consult with and be represented by counsel at every stage of these proceedings. Those rights and the manner in which the proceedings will be conducted are described in West Virginia Code: §27-5-4. Given under my hand this ________ day of _______________________, 20_____. ___________________________________________________________________________ CLERK OF THE CIRCUIT COURT SCA-MH 911 / 4-02 American LegalNet, Inc. www.FormsWorkflow.com