1. This court has received your objection to hospitalization/admission without a hearing and will conduct a hearing to decide
  whether you need to be in a hospital or facility. If this court agrees, you will be allowed to leave.

2. A hearing on your objection will be held at:

In the matter of 
 

Location

  before Judge 

Address

 

 

 

 

 

Date                                                                                                            Time

3. You are entitled to be represented by an attorney. The court has appointed:

Bar no.

Attorney name                                                                                                           Bar no.

City, state, zip                                                                                                 Telephone no.

If you desire to employ an attorney of your own choice, you may do so. If you prefer an attorney other than the one appointed
 
for you, and the preferred attorney agrees to accept the employment and notifies the court of his/her appearance on your
 
  behalf, the court will replace the attorney now appointed for you. If you feel you are unable to pay for an attorney, and the
  court agrees, the court will see that your attorney is paid from public funds at the court approved rate.

4. You have the right to be present at the hearing. If you fail to attend the hearing after having an opportunity to meet with your
  attorney, you will be considered to have waived your right to attend and the hearing may be held without you.

5. For administrative admission only (applies to individuals with developmental disability): You may also ask for an independent medical
  or psychological evaluation. If you feel you are unable to pay for this, and the court agrees, the court will see that the 
  evaluation is paid for from public funds. You should discuss the need for an independent medical or psychological evaluation
  with your attorney.

6. You should discuss your rights with your attorney.

Date

 

Deputy probate register/clerk

Do not write below this line - For court use onlyPCM 204 (2/19) NOTICE OF HEARING AND APPOINTMENT OF ATTORNEY ON OBJECTION TO HOSPITALIZATION OR                         ADMINISTRATIVE ADMISSIONMCL 330.1475a, MCL 330.1498n, MCL 330.1511, MCR 5.744(D)Approved, SCAO JIS CODE: NOHSTATE OF MICHIGANPROBATE COURTCOUNTY OFNOTICE OF HEARING AND APPOINTMENTOF ATTORNEY ON OBJECTION TOHOSPITALIZATION ORADMINISTRATIVE ADMISSIONFILE NO.