Free pcm217a.pmd - Michigan

Approved, SCAO

JIS CODE: C9M

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

ORDER TO MODIFY ORDER FOR ALTERNATIVE TREATMENT OR COMBINED HOSPITALIZATION AND ALTERNATIVE TREATMENT

FILE NO.

In the matter of 1. Date of hearing: 2. This court issued an initial second Judge:
Bar no.

continuing

order on
Date

directing the individual

named above to undergo a program of alternative treatment or combined hospitalization and alternative treatment. 3. The court has been notified that the individual is not complying with the order for alternative treatment or combined hospitalization and alternative treatment. alternative treatment has not been or will not be sufficient to prevent harm or injury the individual may inflict upon self or others. the individual believes that the alternative treatment program is not appropriate. 4. THE COURT FINDS:

IT IS ORDERED: 5. The order for alternative treatment or combined hospitalization and alternative treatment is modified and the individual shall undergo a program of alternative treatment under the supervision of community mental health services program a mental health agency or professional as follows:

This alternative treatment shall not exceed the time from the date of issuance of the initial second continuing order. 6. The order for alternative treatment or combined hospitalization and alternative treatment is modified and the individual shall be hospitalized at for the remainder of the previously-ordered hospitalization portion of the initial second continuing combined order. (PLEASE SEE OTHER SIDE)

Do not write below this line - For court use only

PCM 217a (9/07)

ORDER TO MODIFY ORDER FOR ALTERNATIVE TREATMENT OR COMBINED HOSPITALIZATION AND ALTERNATIVE TREATMENT MCL 330.1475, MCR 5.744

7. The order for alternative treatment or combined hospitalization and alternative treatment is modified and the individual shall continue to undergo combined hospitalization and alternative treatment for the remainder of the previously-ordered period. The individual shall be hospitalized at for a period not to exceed the remainder of the initially ordered hospitalization portion of the initial second continuing combined order. Alternative treatment shall be under the supervision of community mental health services program a mental health agency or professional as follows:

NOTICE: The court must be promptly notified of the individual's release from the hospital to the alternative treatment program, along with a psychiatrist's statement that the individual is clinically appropriate for alternative treatment. 8. If the individual refuses to comply with a psychiatrist's order to return to the hospital, a peace officer shall take the individual into protective custody and transport the individual to the hospital designated by the psychiatrist. 9. This order expires on
Date

.

Date

Judge

NOTICE OF RIGHT TO OBJECT TO HOSPITALIZATION This court has ordered you to be hospitalized rather than continue in an alternative treatment program. You have a right to object to this hospitalization. If you wish to object, complete the objection below and send a copy to the court.

PROOF OF SERVICE I certify that this notice was personally served on the individual named above on and a copy was mailed to the
Date

at Court on
Date

Time

.

Signature

OBJECTION TO HOSPITALIZATION I object to my hospitalization and request that the court schedule a hearing on the objection.

Date

Signature