Free pc665.pmd - Michigan

Approved, SCAO

JIS CODE: OPI

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY

FILE NO.

In the matter of 1. Date of hearing: Judge:

, an individual with a developmental disability

Bar no.

2. The guardian has filed a petition requesting authority to execute an application for admission of the individual to a facility. THE COURT FINDS: 3. Notice of hearing was given to or waived by all interested persons. 4.
Name

is the guardian of the person for the individual named above.

5. From testimony given in open court and from the report and evaluation filed with the court, the individual requires care and services at
Name of facility

.

6. The placement offers appropriate treatment and residential programs to meet the individual's need. 7. There appears to be no less restrictive treatment and residential program available to meet the individual's needs. IT IS ORDERED: 8. The guardian is authorized to execute the necessary application for the temporary administrative admission not to exceed 30 days administrative admission admission of the individual named above to
Name of facility

.

Date

Judge

Do not write below this line - For court use only

PC 665 (9/07)

ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY

MCL 330.1623, MCR 5.746(B)