Here is the text we could read:
STATE OF MICHIGAN
CASE NO. and JUDGE
PROBATE COURT
COUNTY
CONTINUING ORDER
FOR MENTAL HEALTH TREATMENT
Court address
Court telephone no.
In the matter of
First, middle, and last name
Last 4 digits of SSN
asserting that the individual named
1. A petition has been filed by
Petitioner name (type or print)
above is a person requiring treatment.
THE COURT FINDS:
2. Notice of hearing has been given according to law.
3. The individual
The hearing was
was present in court.
with
without a jury.
was not present for reasons stated on the record.
Present were:
, attorney for the individual, and
4. Testimony of a physician, psychiatrist, or licensed psychologist was waived by the individual and the individual's
attorney.
, attorney for the petitioner.
5.
Testimony was given by
Testimony was not given because the parties stipulated to entry of the order.
.
threats that are substantially supportive of this expectation.
6. By clear and convincing evidence, the individual continues to be a person requiring treatment because the individual has
a mental illness,
a. and as a result of that mental illness can reasonably be expected within the near future to intentionally or
unintentionally seriously physically injure self or others, and has engaged in an act or acts or made significant
b. and as a result of that mental illness is unable to attend to those basic physical needs that must be attended to
in order to avoid serious harm in the near future, and has demonstrated that inability by failing to attend to
those basic physical needs.
c. whose judgment is so impaired by that mental illness, and whose lack of understanding of the need for treatment
has caused him or her to demonstrate an unwillingness to voluntarily participate in or adhere to treatment that is
necessary, on the basis of competent clinical opinion, to prevent a relapse or harmful deterioration of his or her
condition, and presents a substantial risk of significant physical or mental harm to the individual or others.
is
is not an available treatment program that is an alternative to hospitalization or that follows an
initial period of hospitalization adequate to meet the individual's treatment needs, is sufficient to prevent harm that
the individual may inflict upon self or others within the near future, and there is an agency or mental health
7. There
professional available to supervise the individual’s treatment program.
Approved, SCAO
Form PCM 219a, Rev. 5/22
MCL 330.1401, MCL 330.1464a, MCL 330.1468, MCL 330.1469a,
MCL 330.1470, MCL 330.1472a(3), (4)
Page 1 of 3
Court ORIDate of birthDriver’s license no.Place of birthRaceSexCurrent address of individualPCS Code: COTTCS Code: CORDXXX-XX- Continuing Order for Mental Health Treatment
Page 2 of 3
(5/22)
Case No.
hospital can provide treatment
8.
that is adequate and appropriate to the individual’s condition.
9. The individual is not a person requiring treatment.
IT IS ORDERED:
10. The individual shall be hospitalized for up to one year.
11. The individual shall receive combined hospitalization and assisted outpatient treatment for no longer than one year.
The individual shall be hospitalized for up to
12. The individual shall receive assisted outpatient treatment for no longer than one year.
days of the assisted outpatient treatment period.
An initial hospitalization period shall be up to
days.
13. Any hospitalization of the individual for mental health treatment shall occur in the hospital listed in item 8.
14. Any assisted outpatient treatment services shall be supervised by
Community mental health services or other designated entity
group therapy
partial day programs
case management plan
case management services
all services recommended by the treatment provider
medication
blood or urinalysis tests to determine compliance with or effectiveness of prescribed medication
individual therapy
day programs
educational training
supervised living
assertive community treatment team services
substance use disorder treatment
substance use disorder testing (for individuals with a history of alcohol or substance use and for whom testing is
The following assisted outpatient services are ordered:
necessary to assist the court in ordering treatment designated to prevent deterioration)
any other services prescribed to treat the individual’s mental illness and either to assist the individual in living and
functioning in the community or to help prevent a relapse or deterioration that may reasonably be predicted to result
in suicide or the need for hospitalization. Those services are:
individual and group therapy
vocational training
.
15. The petition is
denied on the merits.
dismissed.
withdrawn.
16. If the individual refuses to comply with a psychiatrist's order for hospitalization, a peace officer shall take the individual
into protective custody and transport the individual to the hospital designated by the psychiatrist.
17. If item 10 or 11 is checked, the Michigan State Police shall immediately enter the individual’s identifying information
in this court order on LEIN.
Continuing Order for Mental Health Treatment
Page 3 of 3
(5/22)
Case No.
18. If felony charges have been previously dismissed under MCL 330.2044(1)(b) and the time for petitioning to refile
charges has not elapsed, not less than 30 days before the scheduled release or discharge:
a. the director of the treating facility shall notify the prosecutor's office in the county in which charges against the person
were originally brought that the patient's release or discharge is pending.
b. the patient to be released or discharged shall undergo a competency examination as described in MCL 330.2026.
A copy of the written report of the examination along with the notice required in item 18a above shall be submitted
to the prosecutor's office in the county in which the charges against the patient were originally brought. The written
report is admissible as provided in MCL 330.2030(3).
Judge signature and date
PCM 219a, Continuing Order for Mental Health Treatment
This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts.
To learn more about the project, check out our about page.
Downloads: You can download both the original form (last checked 2023-03)
and the machine-processed form with normalized data fields.
About This Form:
- Sourced from www.courts.michigan.gov/MH-Forms (2023-03)
- Page(s): 3
- Fields(s): 66
- Average fields per page: 22
- Reading Level: Grade 15
- LIST Grouping(s):
HE-03-00-00-00, HE-00-00-00-00, ES-05-00-00-00.
Use our Rate My PDF tool to learn more.
Go beyond the above insights and learn more about this or any pdf form at
RateMyPDF.com, includes: counts of difficult words used,
passive voice decetion, and suggestions for how to make the form more usable.
Identified Data Fields:
We have done our best to automaticly identify and name form fields according to our naming conventions.
When possible, we've used names tied to our question library. See e.g., user1_name.
If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.
Here are the fields we could identify.
matter was In the matter of (0.51 conf)court_ori was Court ORI (0.49 conf)users1_birthdate was Date of birth (1.00 conf)drivers_license was Drivers license no (0.53 conf)place_birth was Place of birth (0.37 conf)race was Race (0.41 conf)sex was Sex (0.38 conf)current_address_individual was Current address of individual (0.39 conf)petition_filed was 2 A petition has been filed by (0.43 conf)present_court was was present in court (0.36 conf)with was with (0.31 conf)present_reasons_stated was was not present for reasons stated on the record (0.37 conf)without was without (0.45 conf)present was Present were (0.38 conf)attorney_petitioner was attorney for the petitioner (0.44 conf)physician_individual was 5 Testimony of a physician psychiatrist or licensed psychologist was waived by the individual and the individuals (0.38 conf)testimony_given was Testimony was given by (0.41 conf)given_parties_stipulated was Testimony was not given because the parties stipulated to entry of the order (0.39 conf)undefined was undefined (0.38 conf)clear_evidence_person was 7 By clear and convincing evidence the individual continues to be a person requiring treatment because the individual has (0.39 conf)expected_within_near was a and as a result of that mental illness can reasonably be expected within the near future to intentionally or (0.36 conf)illness_unable_physical_must was b and as a result of that mental illness is unable to attend to those basic physical needs that must be attended to (0.44 conf)illness_lack_understanding was c whose judgment is so impaired by that mental illness and whose lack of understanding of the need for treatment (0.41 conf)8_there was 8 There (0.39 conf)is was is (0.32 conf)is_not was is not (0.34 conf)county was County (0.39 conf)judge was Judge (0.39 conf)court_address was Court address (0.42 conf)court_telephone was Court telephone no (0.51 conf)text was Text3 (0.35 conf)page was Page 2 of 3 (0.42 conf)unknown was 9 (0.38 conf)individual_requiring_treatment was 10 The individual is not a person requiring treatment (0.42 conf)individual_shall_one was 11 The individual shall be hospitalized for up to one year (0.38 conf)individual_receive_combined was 12 The individual shall receive combined hospitalization and assisted outpatient treatment for no longer than one year (0.35 conf)individual_receive_outpatient was 13 The individual shall receive assisted outpatient treatment for no longer than one year (0.41 conf)individual_shall_hospitalized was The individual shall be hospitalized for up to (0.42 conf)initial_hospitalization_period was An initial hospitalization period shall be up to (0.38 conf)outpatient_treatment_period was days of the assisted outpatient treatment period (0.33 conf)assisted_outpatient_supervised was 15 Any assisted outpatient treatment services shall be supervised by (0.28 conf)case_managment_plan was case managment plan (0.36 conf)case_managment_services was case managment services (0.39 conf)services_recommended_provider was all services recommended by the treatment provider (0.32 conf)medication was medication (0.35 conf)effectiveness_prescribed_medication was blood or urinalysis tests to determine compliance with or effectiveness of prescribed medication (0.45 conf)individual_therapy was individual therapy (0.32 conf)day_programs was day programs (0.40 conf)educational_training was educational training (0.41 conf)supervised_living was supervised living (0.25 conf)assertive_community_services was assertive community treatment team services (0.35 conf)substance_disorder_treatment was substance use disorder treatment (0.39 conf)use_disorder_individuals was substance use disorder testing for individuals with a history of alcohol or substance use and for whom testing is (0.46 conf)individuals_illness_assist was any other services prescribed to treat the individuals mental illness and either to assist the individual in living and (0.36 conf)group_terapy was group terapy (0.39 conf)individual_group_therapy was individual and group therapy (0.33 conf)partial_day_programs was partial day programs (0.36 conf)vocational_training was vocational training (0.36 conf)community_help_may was functioning in the community or to help prevent a relapse or deterioration that may reasonably be predicted to result (0.41 conf)need_hospitalization_services__1 was in suicide or the need for hospitalization Those services are 1 (0.36 conf)need_hospitalization_services__2 was in suicide or the need for hospitalization Those services are 2 (0.36 conf)petition was 16 The petition is (0.40 conf)denied_merits was denied on the merits (0.35 conf)dismissed was dismissed (0.46 conf)withdrawn was withdrawn (0.36 conf)individual_officer_shall was 17 If the individual refuses to comply with a psychiatrists order for hospitalization a peace officer shall take the individual (0.36 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
Suggested Screen 1:
Suggested Screen 2:
place_birthpresent_courtpresent_reasons_statedpresentclear_evidence_personillness_lack_understandingpagepartial_day_programscommunity_help_maydenied_merits
Suggested Screen 3:
court_oripetition_filedattorney_petitionercourt_addresscourt_telephonepetitiondismissed
Suggested Screen 4:
Suggested Screen 5:
matterwithout8_thereisis_not
Suggested Screen 6:
Suggested Screen 7:
Suggested Screen 8:
Suggested Screen 9:
drivers_licensecurrent_address_individualtestimony_givenindividual_requiring_treatmentindividual_shall_oneindividual_shall_hospitalizedindividual_officer_shall
Suggested Screen 10:
physician_individualgiven_parties_stipulatedindividual_receive_combinedindividual_receive_outpatientcase_managment_planwithdrawn
Suggested Screen 11:
withinitial_hospitalization_periodoutpatient_treatment_periodassisted_outpatient_supervisedindividual_therapysubstance_disorder_treatmentindividual_group_therapy
Suggested Screen 12:
medicationeffectiveness_prescribed_medication
Suggested Screen 13:
educational_trainingvocational_training
Suggested Screen 14:
users1_birthdateexpected_within_nearillness_unable_physical_mustunknowncase_managment_servicesservices_recommended_providerday_programssupervised_livingassertive_community_servicesuse_disorder_individualsindividuals_illness_assistgroup_terapyneed_hospitalization_services__1need_hospitalization_services__2
Create an Interactive Version of this Form:
The Weaver creates a draft guided interview from a template form, like the one provided here.
To learn more, read "Weaving" your form into a draft interview.
