In the matter of 

First, middle, and last name

1. Date of hearing: 

 

2. A petition has been filed by 

 Judge: 

Petitioner name (type or print)

 asserting that the individual

Bar no.

  named above meets the criteria for judicial admission for treatment and that the court should order the individual to be 
  admitted to a facility.

3. The court finds that notice of hearing has been given according to law. The parties were present.

4. The hearing was 

 

 with 

 without 

  a jury.

5. The court received and considered the report on the petition for judicial admission for treatment.

 .

6. Testimony was given by 
 

THE COURT FINDS:

 a.  can be reasonably expected within the near future to intentionally or unintentionally seriously physically injure self 

 7. The individual is an adult, has been diagnosed as an individual with an intellectual disability, and 
   
            or others, and has overtly acted in a manner substantially supportive of that expectation.
   

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

 

 is 

 8. There 
  an available program of care and treatment other than admission to a facility adequate to
    meet the individual’s care and treatment needs and that is sufficient to prevent harm or injury which the individual may
    inflict upon self or others.

 is not 

 9. 
    adequate and appropriate for his/her condition in the least restrictive environment located nearest to his/her residence.

 facility can provide the individual with the care and treatment 

 

 10.  The individual or a relative requested that the individual be admitted to 
 
      private licensed hospital that complies with the duties and requirements for facilities, and has agreed to pay the costs
      with private funds.

 , a

 11.  The individual does not meet the criteria for judicial admission for treatment.

IT IS ORDERED:
12.  The petition is 
 

 
 13.  The individual be admitted to

 

 granted. 

 

 denied on the merits. 

 

 dismissed/withdrawn.

     

 a. a facility designated by the department and recommended by the community mental health services program.

     

 b. 

Name of licensed hospital

 , which has accepted the individual.

 
 
 

 
 

 

 
 

 

 

Do not write below this line - For court use onlyPCM 214a (2/19) ORDER FOLLOWING HEARING ON PETITION FOR JUDICIAL ADMISSIONMCL 330.1515, MCL 330.1518,MCL 330.1519, MCL 330.1520,MCL 330.1525Approved, SCAO JIS CODE: OJASTATE OF MICHIGANPROBATE COURTCOUNTY OFORDER FOLLOWING HEARING ON PETITION FOR JUDICIAL ADMISSIONFILE NO.(PLEASE SEE OTHER SIDE)     

     

     

 

 

 

 
 

 

 

 

 

 
 
 

 
 
 
 

 14.  The individual undergo alternative care and treatment for a period not to exceed one year. Alternative treatment shall be
     
      under the supervision of 

 as follows:

 

File No. 
 

      If previously admitted to a facility, the individual shall be discharged.

15.  If a resident is discharged by the director of a facility under MCL 330.1525(1) or (2), the facility must notify the 
 
 

  court and community mental health services program.  If a resident met the criteria for treatment under MCL 330.1515(b), 
  the prosecuting attorney must also be notified of the discharge by a facility.

16.  If felony charges have been previously dismissed under MCL 330.2044(1)(b) and the time for petitioning to refile
 

  charges has not elapsed,

  a. not less than 30 days before the resident’s scheduled release or discharge, the director of the treating facility shall notify
      the prosecutor’s office in the county in which charges against the resident were originally brought that the resident’s
      release or discharge is pending.

  b. not less than 30 days before the resident’s scheduled release or discharge, the resident 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 16a above shall be submitted to the prosecutor’s office in the county in which the charges against the resident
      were originally brought. The written report is admissible as provided in MCL 300.2030(3).

Date

 

Judge

Order Following Hearing on Petition for Judicial Admission (2/19)