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Here is the text we could read:

In the matter of

First, middle, and last name

1. The individual presently resides at
own home or with relatives

a facility

a hospital

a private facility

and the address is

2. The individual was placed on authorized leave on

and continues on leave status.

3. By order of this court dated

the individual was placed in a

a. one-year assisted outpatient treatment program.
b. one-year combined treatment program.
c. one-year continuing hospitalization program.
d. facility as a judicial admission.

4. I believe the individual has mental illness and

a. as a result of that mental illness, the individual 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 threats

that are substantially supportive of this expectation.

b. as a result of that mental illness, the individual 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. the individual’s 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.

5. I believe the individual has an intellectual disability and

a. 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.
b. has been arrested and charged with an offense that was a result of the intellectual disability.

Approved, SCAODo not write below this line - For court use only(SEE SECOND PAGE)STATE OF MICHIGANPROBATE COURTCOUNTY OF SIX-MONTH REVIEW REPORTFILE NO.PCM 226 (12/19) SIX-MONTH REVIEW REPORTMCL 330.1482, MCL 330.1483, MCL 330.1515, MCL 330.1531PCS CODE: SRRTCS CODE: SMRR6. This conclusion is based on
a. the following facts of which I have personal knowledge:

File No.

b. the following facts, which are based on reports by others whose names and addresses, if known, are:

7. The treatment provided to the individual since the order and the results are:

8. This treatment

is not adequate and appropriate to the individual's condition. The estimated time required

for further treatment is

days.

months. The following modifications in treatment are currently planned

during the next six-month period, or proposed as

assisted outpatient treatment,
(For judicial admission) outpatient program of care and treatment,

and will be adequate and appropriate to the individual's condition: (Write "none" if no modifications are expected.)

9. The individual

should be discharged from the treatment program.
continues to be a person requiring treatment.
continues to be a person meeting the criteria for judicial admission for treatment.

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.

Six-month Review Report (12/19)

PCM 226, Six-Month Review Report

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): 2
Fields(s): 52
Average fields per page: 26
Reading Level: Grade 19
LIST Grouping(s): HE-00-00-00-00, HE-03-00-00-00.

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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.

stat_e_f_n_cour_count was STATE OF MICHIGAN PROBATE COURT COUNTY OF (0.67 conf)
first_middle_last_name was First middle and last name (0.37 conf)
home_relatives was own home or with relatives (0.40 conf)
facility was a facility (0.41 conf)
hospital was a hospital (0.40 conf)
undefined__1 was undefined_2 (0.39 conf)
undefined__2 was undefined_3 (0.39 conf)
individual_placed_authorized was 2 The individual was placed on authorized leave on (0.41 conf)
continues_leave_status was and continues on leave status (0.42 conf)
individual_placed was the individual was placed in a (0.36 conf)
assisted_outpatient_program was a oneyear assisted outpatient treatment program (0.33 conf)
b_oneyear_combined_treatment_program was b oneyear combined treatment program (0.33 conf)
c_oneyear_continuing_hospitalization_program was c oneyear continuing hospitalization program (0.31 conf)
facility_judicial_admission was d facility as a judicial admission (0.36 conf)
expected_within_near was a as a result of that mental illness the individual can reasonably be expected within the near future to intentionally or (0.33 conf)
individual_unable_physical_must was b as a result of that mental illness the individual is unable to attend to those basic physical needs that must be attended (0.43 conf)
illness_lack_understanding was c the individuals judgment is so impaired by that mental illness and whose lack of understanding of the need for treatment (0.39 conf)
individual_disability was 5 I believe the individual has an intellectual disability and (0.29 conf)
reasonably_intentionally_unintentionally was a can be reasonably expected in the near future to intentionally or unintentionally seriously physically injure self or (0.34 conf)
arrested_charged_intellectual was b has been arrested and charged with an offense that was a result of the intellectual disability (0.37 conf)
private_facility was a private facility (0.43 conf)
checkbox was CHECKBOX (0.35 conf)
following_personal_knowledge__1 was a the following facts of which I have personal knowledge 1 (0.39 conf)
following_personal_knowledge__2 was a the following facts of which I have personal knowledge 2 (0.39 conf)
following_facts_reports_whose__1 was b the following facts which are based on reports by others whose names and addresses if known are 1 (0.35 conf)
following_facts_reports_whose__2 was b the following facts which are based on reports by others whose names and addresses if known are 2 (0.35 conf)
undefined__3 was undefined_4 (0.39 conf)
provided_individual_since__1 was 7 The treatment provided to the individual since the order and the results are 1 (0.34 conf)
provided_individual_since__2 was 7 The treatment provided to the individual since the order and the results are 2 (0.34 conf)
provided_individual_since__3 was 7 The treatment provided to the individual since the order and the results are 3 (0.34 conf)
provided_individual_since__4 was 7 The treatment provided to the individual since the order and the results are 4 (0.34 conf)
provided_individual_since__5 was 7 The treatment provided to the individual since the order and the results are 5 (0.34 conf)
is was is (0.32 conf)
is_not was is not (0.34 conf)
treatment was for further treatment is (0.33 conf)
days was days (0.38 conf)
following_modifications_currently was months The following modifications in treatment are currently planned (0.30 conf)
assisted_outpatient_treatment was assisted outpatient treatment (0.39 conf)
admission_program_care was For judicial admission outpatient program of care and treatment (0.39 conf)
adequate_appropriate_expected__1 was and will be adequate and appropriate to the individuals condition Write none if no modifications are expected 1 (0.37 conf)
adequate_appropriate_expected__2 was and will be adequate and appropriate to the individuals condition Write none if no modifications are expected 2 (0.37 conf)
adequate_appropriate_expected__3 was and will be adequate and appropriate to the individuals condition Write none if no modifications are expected 3 (0.37 conf)
adequate_appropriate_expected__4 was and will be adequate and appropriate to the individuals condition Write none if no modifications are expected 4 (0.37 conf)
adequate_appropriate_expected__5 was and will be adequate and appropriate to the individuals condition Write none if no modifications are expected 5 (0.37 conf)
discharged_treatment_program was should be discharged from the treatment program (0.37 conf)
person_requiring_treatment was continues to be a person requiring treatment (0.43 conf)
meeting_criteria_admission was continues to be a person meeting the criteria for judicial admission for treatment (0.37 conf)
information_knowledge_belief was my information knowledge and belief (0.28 conf)
undefined__4 was undefined_5 (0.39 conf)
name_type_print was Name type or print (0.45 conf)
title was Title (0.27 conf)
text was Text1 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

PCM 226, Six-Month Review Report

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02