Free pcm202.pmd - Michigan


File Size: 26.6 kB
Pages: 1
Date: February 13, 2008
File Format: PDF
State: Michigan
Category: Court Forms - State
Author: GentilozziT
Word Count: 182 Words, 1,066 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://courts.michigan.gov/scao/courtforms/mentalhealth/pcm202.pdf

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Approved, SCAO

JIS CODE: OBH

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

OBJECTION TO HOSPITALIZATION OF A MINOR

FILE NO.

In the matter of 1. I object to the hospitalization of this minor and request the court to schedule a hearing on this objection.
Date Signature

, a minor

1. The person filing this objection is
Name

and is

the minor patient, who is 14 years of age or older. the minor's parent, guardian, or person in loco parentis. The request for hospitalization was made by the minor or a peace officer. a person designated by the court. was admitted is scheduled for admission

2. The minor is

years old and

to

upon the application of
Address City State Zip Telephone no.

who is the minor's

parent, guardian, person in loco parentis, i.e. other, i.e.
Date

3. The minor received a periodic review of his/her suitability for continued hospitalization on 4. The reason for this objection is:

.

Do not write below this line - For court use only

PCM 202 (9/07)

OBJECTION TO HOSPITALIZATION OF A MINOR

MCL 330.1498m