CONFIDENTIAL COURT RECORD ME-944, 02/16 Order of Conversion to Guardianship and Protective Placement or Services 24751.20(7)(d), 51.67 and 905.04(4)(a) and (am), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE CONDITION OF Name of Subject Individual Date of Birth Am ended Order of Conversion to Temporary Guardianship and /or Temporary Protective Placement or Services Case No. A hearing was held on [Date] . THE COURT FINDS: 1. The subject individual is a resident of County, Wisconsin. 2. Commitment under Chapter 51, Wis. Stats., is not warranted, and the subject individual is a fit subject for guardianship and protective placement or services. 3. The subject individual is not competent to refuse psychotropic medication under 24724751.67 or 55.14, Wis. Stats. THE COURT ORDERS: 1. This matter shall be converted to an action for temporary guardianship and/or temporary protective placement or services under Chapters 54 and 55, Wis. Stats. 2. The subject individual is temporarily protectively placed at or other appropriate treatment or placement facility for not more than 30 days from the date of this hearing. 3. The guardian may consent to the involuntary administration of psychotropic medication as a temporary protective service. 4. To prepare the permanent guardianship and protective placement or services petition, the department responsible for guardianship or protective placement or services in [County] County and the county corporation counsel or privately retained attorney by temporary guardian shall have access to all court records and to all treatment and service records. 5. The temporary guardian of the subject individual shall be . The current guardian of the subject individual is [Name] [Address] [Phone] 6. This order is valid until [Date] (not more than 30 days from the date of the hearing). American LegalNet, Inc. www.FormsWorkFlow.com ME-944, 02/16 Order of Conversion to Guardianship and Protective Placement or Services 24751.20(7)(d), 51.67 and 905.04(4)(a) and (am), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 DISTRIBUTION: 1. Court 2. Corporation Counsel 3. Subject Individual 4. Subject Individual Attorney 5. Facility 6. Human or Social Services 7. Temporary Guardian 8. Other intereste d persons: American LegalNet, Inc. www.FormsWorkFlow.com