ME-908A, 09/14 Settlement Agreement 24751.20(8)(bg), (bm), and (br), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE CONDITION OF Name of Subject Date of Birth Settlement Agreement Case No. 1. The subject A. stipulates to a finding of probable cause as to the criteria under 24751.20(1), Wis. Stats., and waives the time period for holding a final hearing for days. B. waives the time period for holding a probable cause hearing and a final hearing for days. C. waives the time period for holding a final hearing for days. D. refuses or is unable to sign the agreement, but agrees to waive time periods for hearings for days. 2. The subject agrees to comply with the following treatment and conditions for the term of this Agreement: A. Take all prescribed doses of psychotropic medications. B. Keep all appointments with treatment providers and ca se management staff. C. Cooperate with psychiatric and psychological testing, therapy, and recommendations. D. Keep case management or treatment staff advised of current residential address or location. E. Refrain from acts, attempts or threats of harm to self or others. F. Refrain from ingesting any controlled sub stances not prescribed for subject. G. Refrain from consuming alcoholic beverages. H. Remain in an inpatient treatment facility until discharged, but not later than . I. Other: 3. Either party may request the court to modify the treatment plan. 4. The subject agrees to waive confidentiality of treatment records to allow monitoring of the subject's compliance. 5. Upon receipt of a sworn statement alleging the subject's failure to comply with this Agreement, the court A. may issue an order to detain the subject at an approved inpatient treatment facility. B. shall, upon subject's motion, hold a hearing on the issue of noncompliance with the Agreement within 72 hours of the filing of the motion. C. shall hold either a probable cause or final hearing, as required. 6. The proceeding will be dismissed on , if the subject complies with this Agreement. Signature Subject Date Number Signature Date Telephone Number Signature Corporation Counsel Date American LegalNet, Inc. www.FormsWorkFlow.com