Free Appeal of Commitment and Order to Reconvene Commitment Review Panel - Michigan

Approved, SCAO

STATE OF MICHIGAN JUDICIAL CIRCUIT COURT COUNTY

APPEAL OF COMMITMENT AND ORDER TO RECONVENE COMMITMENT REVIEW PANEL

CASE NO.

In the matter of CLAIM OF APPEAL 1. I was committed to and am presently in
Name of facility

, .

as ordered by the court on
Date

2. I claim an appeal of my commitment. I REQUEST that the court reconvene my commitment review panel for a recommendation as to whether my commitment should be terminated. I understand that the court will reconvene the commitment review panel as soon as possible, but not more than 14 days after I have filed this claim of appeal.

Date

Signature

ORDER 1. Date of Hearing: IT IS ORDERED: 2. The previously appointed commitment review panel consisting of
Name

Judge:
Bar no.

,
Name

, and
Name

shall reconvene and report to the court in writing within 14 days of the date of this order. 3. The panel shall do the following: a. Review the appeal and any other information considered relevant by the commitment review panel. b. Interview the individual, or document the reasons why the individual was not interviewed. c. Recommend to the circuit court either termination or continuation of the commitment and document the reasons for the recommendation.

Date

Judge

Do not write below this line - For court use only

MCL 333.5205(10); MSA 14.15(5205(10), MCR 5.782 PC 113 (6/98)

APPEAL OF COMMITMENT AND ORDER TO RECONVENE COMMITMENT REVIEW PANEL