Approved, SCAO

STATE OF MICHIGAN
JUDICIAL CIRCUIT COURT
COUNTY

ORDER FOLLOWING HEARING ON
PETITION TO CONTINUE
TEMPORARY DETENTION

CASE NO.

In the matter of

1. Date of Hearing:

Judge:

2. A petition and affidavit have been filed by a

   local health officer

Community Health Department representative

asserting that an emergency exists.  The court issued an ex parte order for immediate temporary detention of the individual.

THE COURT FINDS:

3. Notice of hearing was given to the individual.

4. The individual is temporarily detained at

Name of facility

detained in a facility.

IT IS ORDERED:

5. There

is           is not     a preponderance of evidence that the individual would pose a threat to others if not temporarily

Bar no.

    .

6. The individual shall continue to be temporarily detained at

or other appropriate emergency care or treatment facility.

Name of facility where presently found

a. A petition for treatment of infectious disease of the individual has been filed with this court and the facility shall continue

temporary detention of the individual until the further order of the court.

b. Unless a petition for treatment of infectious disease of the individual is filed with the court, the facility shall discharge

the individual five days from the date of this order.

7. The individual is discharged from the facility.

Date

Judge

Do not write below this line - For court use only

PC 112   (6/98)   ORDER FOLLOWING HEARING ON PETITION TO CONTINUE TEMPORARY DETENTION

MCL 333.5207(5); MSA 14.15(5207(5), MCR 5.782