Free CCCO 0085 - Illinois

Order of Detention, Examination, Evaluation (This form replaces 85-MHDD-8) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - COUNTY DIVISION IN THE MATTER OF:

(Rev. 7/6/01) CCCO 0085 A

______________________________________________________________ ! Asserted to be a person subject to involuntary admission.

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No. _______________________________________

! Asserted to be mentally retarded and in need of judicial admission. This matter coming to be heard on the Petition of ____________________________________________________ and the Court having been fully advised: The Court finds as follows: ! Subject person is in need of an examination. ! Subject person is in need of detention and examination. IT IS ORDERED THAT ____________________________________________________________ submit to an examination by: ! a qualified examiner, ! clinical psychologist, ! a physician, or ! psychiatrist, within 24 hours of arrival at ____________________________________________________________________
(Name of hospital)

IT IS FURTHER ORDERED THAT: ! The respondent be allowed to remain in his/her place of residence until such time as he/she be examined. ! The peace officer of _______________________________________________________________________________________
(City, Village, County)

is commanded to take custody of: ___________________________________________________________________________
(Respondent's name and address)

and IMMEDIATELY take him/her to: ________________________________________________________________________________________________________
(Name of local mental health facility)

________________________________________________________________________________________________________
(Address of local mental health facility)

for detention and examination pursuant to this Order of the Court. A qualified staff person is hereby appointed to examine _____________________________________________________________ and report to this Court within 24 hours of admission. ! Clerk of the Court shall certify this Order of the Court. Witness: Entered: _____________________________________________ Judge Judge's No. Date: ______________________________________, _________ Date: ____________________________________, _________ ___________________________________________________ Clerk of Court NOTICE: This Order is in effect for 72 hours. It expires _______________________________, _________ at ____________. m. SEE BACK OF THIS FORM FOR RETURN DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

(Rev. 7/6/01) CCCO 0085 B

RETURN
On ______________________________, _________ at ______________. m., I took custody of _________________________________________________ and brought him/her to ____________________ _____________________________________________________________________________ as commanded _______________________________________, _________.

_________________________________________________ Signature

TO BE COMPLETED AT THE FACILITY ( if applicable)
On ______________________________, _________ at _____________. m., _______________ ___________________________________________________________________ was received at this facility together with his/her personal property.

Facility: ______________________________________________ Staff Signature: ______________________________________ Title: ________________________________________________ Facility Director: _____________________________________

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS