Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT COURT
COUNTY

ORDER FOLLOWING HEARING ON
PETITION FOR TREATMENT OF
INFECTIOUS DISEASE

CASE NO.

Judge:

Bar no.

2. A petition has been filed asserting that the above named individual is a carrier and health threat to others.

3. Notice of hearing has been given according to law.

4. A commitment review panel has filed its recommendation for

commitment of the individual.
an alternative to commitment of the individual.

In the matter of

1. Date of Hearing:

THE COURT FINDS:

5. The allegations of the petition have not been proven by clear and convincing evidence.

6. By clear and convincing evidence that

a. the individual is a carrier of

           , an infectious agent

or serious communicable disease or infection, and the individual is a health threat to others.

b. the individual has failed or refused to comply with the warning notice.

c. the individual was not given a written warning notice because an emergency existed.

IT IS ORDERED:

7. The individual shall

a. participate in

  education

counseling

treatment

programs at

Name of agency or facility

b. present him/herself within 24 hours at

Name of agency or facility

and undergo tests to verify his/her status as a carrier or for diagnosis purposes.

c. appear within 24 hours at

Name of agency or facility

   for verification of status, testing, or other purposes consistent with monitoring.

(PLEASE SEE OTHER SIDE)

Do not write below this line - For court use only

PC 106   (6/98)   ORDER FOLLOWING HEARING ON PETITION FOR TREATMENT OF INFECTIOUS DISEASE

MCL 333.5205(6), (8); MSA 14.15(5205)(6), (8), MCR 5.782

d. immediately and until further order of the court, cease and desist conduct that constitutes a health threat to others,

including but not limited to

e. live part-time or full-time in a supervised setting at

f. be committed to

Name of facility

for not more than 6 months under the following conditions:

g. other:

by court order.

8. The petition is dismissed and the individual shall be released from any facility where s/he is being temporarily detained

Date

Judge