Free Microsoft Word - MC-420 Conditions of Early Release to Outpatient Treatment... - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity for the Hospitalization of: , Respondent. ) ) ) ) ) )

Case No. CONDITIONS OF EARLY RELEASE TO OUTPATIENT TREATMENT

1.

It has been determined that it is not necessary for the respondent to be treated as an inpatient to prevent him/her from harming himself/herself or others. In addition, there is reason to believe that the respondent's mental condition would improve as a result of outpatient treatment. , a provider of outpatient care located at Alaska, has agreed to accept the respondent for the duration of his/her commitment. Conditions of respondent's early release are:

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Date

Signature of Professional Person In Charge or that Person's Professional Designee Print Name and Title

I certify that on a copy of this document was mailed or delivered to: court respondent respondent's attorney attorney general respondent's guardian (if any) the outpatient treatment center named above By: Treatment Facility Personnel
MC-420 (12/87)(cs) CONDITIONS OF EARLY RELEASE TO OUTPATIENT TREATMENT AS 47.30.795