IN THE CIRCUIT COURT OF _________________ COUNTY, WEST VIRGINIA IN RE: Involuntary Hospitalization of Case No. ________- MH -________ ___________________________________ RESPONDENT ORDER / COMMISSIONER'S RECOMMENDATION CONFIRMATION OF FINAL COMMITMENT HEARING HELD IN ANOTHER COUNTY [W.Va. Code: §27-5-4(n)(2)] This matter came before this Court on the __________ day of ___________________________, 20________, before the Honorable __________________________________________________________, Mental Hygiene Commissioner / Judge of the Circuit Court of ________________________ County, West Virginia, upon the transcript of a final commitment hearing held pursuant to the provisions of West Virginia Code: § 27-5-4(n)(1) in __________________________________ County, West Virginia, and upon the Order certifying the transcript of said hearing duly entered by the Mental Hygiene Commissioner / Circuit Court of said County, the contents of which transcript and Order are incorporated herein by reference. After reviewing the evidence contained in the transcript, the Mental Hygiene Commissioner / Circuit Court is satisfied, and hereby FINDS, that the evidence, under the burdens and standards set forth in West Virginia Code: § 27-5-4, clearly, cogently and convincingly proves that the Respondent should be hospitalized. Accordingly, it is hereby RECOMMENDED [by Commissioner] and ORDERED [by Judge]: 1. That the Respondent be committed, for the time period specified below, to the custody of the Secretary of the Department of Health and Human Resources and be admitted to _________________________________________________________ mental health facility, or such other facility as determined appropriate by said Department. 2. That the commitment herein ordered shall be [initial one] __________ for a temporary period of observation not to exceed six (6) months, or __________ for an indeterminate period not to exceed two (2) years, unless, previous to the expiration of this period, this order is modified or extended by further order of this Court pursuant to the provisions of West Virginia Code: § 27-5-4(k)(3) and (4). 3. That the Respondent be remanded to the custody of the Sheriff of _______________________________________ County, SCA-MH 917(n)(2)-1 / 6-06 § 27-5-4(n)(2) ORDER / CONFIRMATION OF FINAL COMMITMENT- Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com West Virginia, who shall immediately transport the Respondent to such facility. If the Respondent is currently located in the County wherein the hearing was held as aforesaid, the Sheriff shall be given a copy of this Order for delivery to the Circuit Clerk of said County who shall promptly execute the terms hereof as provided under West Virginia Code: § 27-5-4(n)(3). THIS RECOMMENDATION is made this _______ day of ________________________________, 20 ________. ______________________________________________________ MENTAL HYGIENE COMMISSIONER The foregoing findings and recommendations made on the ______ day of ______________________________, 20 _______, by __________________________________________, Mental Hygiene Commissioner of __________________________________ County, West Virginia, having been carefully and fully reviewed by this Court, are hereby adopted, approved and confirmed as the ORDER of the Circuit Court. The Clerk shall enter the foregoing ORDER as of the day and date written below and shall transmit three attested copies to the Sheriff of _____________________________ County, West Virginia, one for presentation with the Respondent at the aforementioned mental health facility, and shall also transmit attested copies to Respondent's counsel of record, the Prosecuting Attorney of this County, and to the _________________________________________ Mental Health Center. In addition thereto, The Clerk is hereby further directed to transmit a certified copy of this ORDER to the Circuit Clerk of ________________________________________ County who shall promptly execute the terms hereof as provided under West Virginia Code: § 27-5-4(n)(3). ENTER this _______ day of _________________________________, 20 __________. _____________________________________________________ JUDGE OF THE CIRCUIT COURT SCA-MH 917(n)(2)-1 / 6-06 § 27-5-4(n)(2) ORDER / CONFIRMATION OF FINAL COMMITMENT- Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com