Free pcm226.p65 - Michigan

Approved, SCAO

JIS CODE: SRR

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

FILE NO. SIX MONTH REVIEW REPORT

In the matter of 1. The individual presently resides at own home or with relatives a center a hospital a private facility

and the address is 2. The individual was placed on authorized leave on 3. By order of this court dated a. one-year alternative treatment program. b. one-year combined treatment program. c. one-year continuing hospitalization program. d. center or private facility as a judicial admission. and continues on leave status. the individual was placed in a

4. I believe the individual has mental illness and a. can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure self or another person, and the individual has engaged in an act or acts or made significant threats that are substantially supportive of the expectation. b. is unable to attend to his or her basic physical needs such as food, clothing, or shelter that must be attended to for the individual to avoid serious harm in the near future, and the individual has demonstrated that inability by failing to attend to those basic physical needs. c. his or her judgment is so impaired that the individual is unable to understand his or her need for treatment, and the individual's continued behavior as the result of this mental illness can reasonably be expected to result in significant physical harm to self or others. 5. I believe the individual has mental retardation and can be reasonably expected in the near future to intentionally or unintentionally seriously physically injure self or another person and has overtly acted in a manner substantially supportive of that expectation. 6. My conclusion is based on the following facts of which I have personal knowledge:

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PCM 226 (9/06)

SIX MONTH REVIEW REPORT

MCL 330.1401, MCL 330.1482, MCL 330.1515, MCL 330.1531

7. My conclusion is based on the following facts, which are based on reports by others whose names and addresses, if known, are:

8. The alternative treatment program provided to the individual since the order, and the results are:

9. This treatment

is is not

adequate and appropriate to the individual's condition, the estimate of time required for further

treatment is

days, months, and the following modifications in treatment are currently planned during the next six-month

period or proposed as alternative treatment and will be adequate and appropriate to the individual's condition:
(write "none" if continuation of previous treatment program[s] is/are the only course of treatment currently envisaged)

10. The individual a. continues to be a person requiring involuntary mental health treatment. b. continues to be a person meeting the criteria for judicial admission. c. should be discharged from the treatment program.

I declare under the penalties of perjury that this report has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Date

Signature of physician or licensed psychologist Name (type or print) Title Telephone no.