Approved, SCAO

STATE OF MICHIGAN

PROBATE COURT
COUNTY
CIRCUIT COURT - FAMILY DIVISION

In the matter of

OBJECTION TO HOSPITALIZATION
OF A MINOR

JIS CODE:  OBH

FILE NO.

, a minor

1. I object to the hospitalization of this minor and request the court to schedule a hearing on this objection.

Date

Signature

1. The person filing this objection is

Name

and is

the minor patient, who is 14 years of age or older.
the minor's parent, guardian, or person in loco parentis. The request for hospitalization was made by the minor or
a peace officer.
a person designated by the court.

2. The minor is

years old and

was admitted
is scheduled for admission

to

upon the application of

City

State

Zip

Telephone no.

Address

who is the minor's

parent,
guardian,
person in loco parentis, i.e.
other, i.e.

3. The minor received a periodic review of his/her suitability for continued hospitalization on

    .

Date

4. The reason for this objection is:

Do not write below this line - For court use only

PCM 202   (9/07)   OBJECTION TO HOSPITALIZATION OF A MINOR

MCL 330.1498m



Objection to Hospitalization of Minor

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): 25
• Average fields per page: 25
• Reading Level: Grade 8
• LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

---

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.

---

Create an Interactive Version of this Form:

The Weaver creates a draft guided interview from a template form, like the one provided here. To learn more, read "Weaving" your form into a draft interview.