FORM SUMMARY Name of Form: Settlement Agreement and Court Approval and Order to Transport Form Number: ME-908 Statutory Reference: §51.20(8)(bg), (bm), and (br), Wisconsin Statutes Benchbook Reference: MH 4-4 Purpose of Form: Resolves mental commitment proceedings with an agreement between the parties Who Completes It: Corporation Counsel, although signed by all parties and the court. Distribution of Form: Original to court, copies to subject, subject's counsel, corporation counsel, department monitoring the agreement, and treatment provider (if different). Accompanying Forms: Usually none. New Form/Modification: Modification; last update 12/02. Modifications: Added checkbox for “transportation to (facility) shall be provided by sheriff/other”. Comments: None. About this Form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 10/11/2007 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, IN THE MATTER OF THE CONDITION OF Name of Subject Settlement Agreement and Court Approval and Order to Transport Case No. Date of Birth 1. The subject: a. Stipulates to a finding of probable cause as to the criteria under §51.20(1), Wis. Stats., and waives the days. 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 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 case 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 substances 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. , if the subject complies with this Agreement. 6. The proceeding will be dismissed on Signature – Subject Signature – Subject‘s Attorney Signature – Corporation Counsel Subject’s Address Attorney’s Telephone Attorney’s Telephone COURT APPROVAL and ORDER TO TRANSPORT department The court approves this Agreement and designates the established under §51.42 or 51.437, Wis. Stats., to monitor the treatment and compliance. The department shall notify the corporation counsel and subject's attorney of noncompliance. other: the sheriff shall be provided by Transportation to (facility) BY THE COURT: Distribution: 1. Court – Original 2. Subject 3. Subject’s Counsel 4. Corporation Counsel 5. County Dept. Monitoring Agreement 6. Treatment Provider (if different) ME-908, 10/07 Settlement Agreement and Court Approval and Order to Transport Circuit Court Judge/Circuit Court Commissioner Name Printed or Typed Date §51.20(8)(bg), (bm), and (br), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkflow.com