IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA IN RE: Involuntary Hospitalization of: Case No. ________- MH -________ ___________________________________ RESPONDENT ORDER: TO CONTINUE AND/OR RESCHEDULE PROCEEDINGS DUE TO RESPONDENT’S NEED OF MEDICAL CARE [W.Va. Code: §27-5-2(e)] On this __________ day of ________________________, 20_______,: [initial appropriate selection(s)] _____ the Court reviewed the Application submitted by Applicant which asserts, _____ came Counsel for Respondent and the Applicant, and advised the Court that, _____ came ______________________________________________________________________________ _____________________________________________________________and advised the Court that, the Respondent is currently inpatient hospitalized at ______________________________________________________________ hospital or is otherwise in need of medical care for a physical condition or disease for which the need for treatment precludes the ability to comply with the time requirements of West Virginia Code § 27-5-2(e), i.e., needs hospitalization and/or emergency or other treatment for the following described physical condition or disease: [describe condition/disease] ________________________________________________ _________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Accordingly it is ORDERED, that: [initial appropriate findings] __________ This matter is continued generally until further order of the Court. __________ The attorney named below is appointed as counsel to represent the Respondent in this matter: NAME OF APPOINTED ATTORNEY: ____________________________________________________ ATTORNEY’S ADDRESS: ______________________________________________________________ _____________________________________________________________ ATTORNEY’S TELEPHONE NUMBER: (_________)_________________________________________ SCA-MH 903M-1 / 4-02 American LegalNet, Inc. www.FormsWorkflow.com Order to Continue or Reschedule - Page 2 of 2 pages __________ The probable cause hearing previously scheduled in this matter is continued/rescheduled to the __________ day of ___________________________, 20______, at the hour of _______________ at the following location: _______________________________________________________________ __________ The probable cause hearing previously scheduled in this matter is continued generally until further order of the Court. __________ Counsel for Respondent and the Applicant shall jointly advise the Court if and when Respondent is medically cleared for release from hospitalization or is otherwise no longer in need of medical care for a physical condition or disease for which the need for treatment precludes the ability to comply with the time requirements of West Virginia Code § 27-5-2(e). ___________ [Insert any additional findings] ________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ The Clerk shall enter the foregoing as of the date first above written and transmit attested copies thereof to the Sheriff of ______________________________ County, to ______________________________________________________________ Mental Health Center, to Appointed Counsel for Respondent, to the Applicant, and to the Prosecuting Attorney of ______________ County for determination of whether it is in the public interest to appear at the probable cause hearing. ___________________________________________________________________ MENTAL HYGIENE COMMISSIONER/CIRCUIT JUDGE/MAGISTRATE SCA-MH 903M-1 / 4-02 NEED OF MEDICAL CARE CONTINUANCE Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com