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JIS CODE: OAO

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

INITIAL ORDER FOLLOWING HEARING ON PETITION FOR ASSISTED OUTPATIENT TREATMENT

FILE NO.

In the matter of
Court ORI Date of birth Race Sex Current address of individual

1. Date of hearing: 2. A petition has been filed by
Petitioner name (type or print)

Judge:
Bar no.

pursuant to MCL 330.1433 asserting

that the individual named above is a person requiring treatment. 3. Notice of hearing has been given according to law. present in court. 4. The individual was not present for reasons stated on the record. Present were

The hearing was

with without

a jury.

, attorney for the individual, and , attorney for the petitioner.

5. Testimony of a physician was waived by the individual and the individual's attorney. 6. Testimony was given by Testimony was not given because the parties stipulated to entry of the order. .

THE COURT FINDS: 7. By clear and convincing evidence, the individual is a person requiring treatment because the individual has a mental illness, and as a result of that mental illness, the individual's understanding of the need for treatment is impaired to the point that he or she is unlikely to participate in treatment voluntarily. 8. The individual is currently noncompliant with treatment that was recommended by a mental health professional and that has been determined to be necessary to prevent a relapse or harmful deterioriation of the individual's condition, and the individual's noncompliance with this treatment has been a factor in his/her placement in a psychiatric hospital, jail, and/or prison at least two times within the last 48 months and/or in committing one or more acts, attempts, or threats of serious violent behavior within the last 48 months. 9. The individual is is not scheduled to begin a course of outpatient mental health treatment that includes case management services or assertive community treatment team services. 10. There is an existing advance directive. pursuant to MCL 330.1712. The individual is is not durable power of attorney. individual plan of services developed

11.

a person requiring treatment. (PLEASE SEE OTHER SIDE)
Do not write below this line - For court use only

MCL 330.1401(1)(d), MCL 330.1433 PCM 243 (9/07)

INITIAL ORDER FOLLOWING HEARING ON PETITION FOR ASSISTED OUTPATIENT TREATMENT

IT IS ORDERED: 12. The individual receive assisted outpatient treatment through the
Name of the local community mental health services program

local community mental health services program to expire on Date be provided as follows:

. Case management services shall

Additionally, one or more of the following is ordered: (see MCL 330.1433[3] for specific provisions that may be ordered)

13. To fulfill the requirements of the above treatment plan, Publicly-funded entity other than the community mental health services program shall: (specify role)

14. Unless the petition is denied, dismissed, or withdrawn, the Michigan Department of State Police shall immediately enter the individual's identifying information in this court order on the law enforcement information network. 15. The petition is denied on the merits. dismissed/withdrawn.

Date

Judge