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

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Here is the text we could read:

In the matter of

First, middle, and last name

PLEASE PRINT OR TYPE CLEARLY

1. I state that I have met with my legal counsel, a representative from the county community mental health program, and a
member of the treatment team assigned to provide treatment. I agree to one of the following:

c. Combined hospitalization and outpatient treatment up to 180 days with hospitalization not to exceed 60 days.

a. Inpatient hospital treatment not to exceed 60 days.

b. Outpatient treatment not to exceed 180 days.

2. The treatment program will be as follows:

Hospitalization:

Outpatient treatment under the supervision of:

3. I request that the court hearing be deferred for not longer than 60 days from today if I have chosen to remain hospitalized, or
180 days from today if I have chosen outpatient treatment or a combination of hospitalization and outpatient treatment.

4. I understand that I may refuse this treatment at any time during this deferral period and demand a court hearing.

Date

Patient’s signature

Witness/Legal counsel

Bar no.

Approved, SCAODo not write below this line - For court use onlySTATE OF MICHIGANPROBATE COURTCOUNTY OF REQUEST TO DEFERHEARING ON COMMITMENTFILE NO.PCM 235 (2/19) REQUEST TO DEFER HEARING ON COMMITMENTMCL 330.1455(6)USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form.PCS CODE: RTDTCS CODE: RDHC

PCM 235, Request to Defer Hearing on Commitment

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): 1
Fields(s): 20
Average fields per page: 20
Reading Level: Grade 10
LIST Grouping(s): HE-03-00-00-00, CO-07-00-00-00, HE-00-00-00-00, CO-00-00-00-00.

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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)
fil_e was FILE NO (0.48 conf)
first_middle_last_name was First middle and last name (0.37 conf)
hospital_treatment_exceed was a Inpatient hospital treatment not to exceed 60 days (0.39 conf)
outpatient_treatment_exceed_days was b Outpatient treatment not to exceed 180 days (0.37 conf)
combined_hospitalization_exceed was c Combined hospitalization and outpatient treatment up to 180 days with hospitalization not to exceed 60 days (0.31 conf)
hospitalization was Hospitalization (0.33 conf)
outpatient_supervision__1 was Outpatient treatment under the supervision of 1 (0.31 conf)
outpatient_supervision__2 was Outpatient treatment under the supervision of 2 (0.31 conf)
outpatient_supervision__3 was Outpatient treatment under the supervision of 3 (0.31 conf)
outpatient_supervision__4 was Outpatient treatment under the supervision of 4 (0.31 conf)
outpatient_supervision__5 was Outpatient treatment under the supervision of 5 (0.31 conf)
outpatient_supervision__6 was Outpatient treatment under the supervision of 6 (0.31 conf)
outpatient_supervision__7 was Outpatient treatment under the supervision of 7 (0.31 conf)
outpatient_supervision__8 was Outpatient treatment under the supervision of 8 (0.31 conf)
outpatient_supervision__9 was Outpatient treatment under the supervision of 9 (0.31 conf)
signature_date was Date (1.00 conf)
witness_legal_counsel was WitnessLegal counsel (0.49 conf)
bar was Bar no (0.41 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 235, Request to Defer Hearing on Commitment

About This Form:

Identified Data Fields:

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