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Here is the text we could read:

STATE OF MICHIGAN

PROBATE COURT
COUNTY

PETITION REGARDING
TRANSPORT OF MINOR

CASE NO. and JUDGE

Court address

Court telephone no.

Date of birth

In the matter of

First, middle, and last name

I represent that:

1. The minor can be currently found at:

State your relationship

MCL 330.1498d or MCL 330.1498h.

2. I have authority as

and I have requested voluntary hospitalization of the minor pursuant to

3. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor

has been previously filed in

Court, Case Number

, was

assigned to Judge

, and

remains

is no longer

pending.

4. The minor has been hospitalized pursuant to Chapter 4A of the Mental Health Code, and the director of

hospital believes the minor should be returned to the hospital following an

authorized

unauthorized

absence.

5. The following unsuccessful efforts by

Name

were made to transport the minor for

evaluation or hospitalization pursuant to Chapter 4A of the Mental Health Code:

6. I request that the court order the minor to be transported for evaluation and/or hospitalization pursuant to Chapter 4A
of the Mental Health Code.

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.

Name (type or pint)

City, state, zip Telephone no.

Address

Date

Signature

Approved, SCAO
Form PCM 240m, Rev. 12/22
MCL 330.1498d(1), MCL 330.1498h, MCL 330.1498k, MCL 330.1498t
Page 1 of 1

JIS Code: PMNPut DOB in Ref. No. row 1 on MC 97.

PCM 240m, Petition Regarding Transport 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): 30
Average fields per page: 30
Reading Level: Grade 8
LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

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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_michiga_n_probat_cour_county was STATE OF MICHIGAN PROBATE COURT COUNTY (0.62 conf)
first_middle_last_name_minor was First middle and last name of minor (0.34 conf)
petition was PETITION (0.45 conf)
minor_currently_found was 1 The minor can be currently found at (0.36 conf)
authority was I have authority as (0.43 conf)
action_division_involving was 3 An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor (0.37 conf)
court_case_number was Court Case Number (0.46 conf)
was was was (0.41 conf)
previously_filed was has been previously filed in (0.40 conf)
remains was remains (0.32 conf)
longer was is no longer (0.37 conf)
minor_pursuant_mental was The minor has been hospitalized pursuant to Chapter 4A of the Mental Health Code and the director of (0.30 conf)
pending was pending (0.47 conf)
believes_returned_following was hospital believes the minor should be returned to the hospital following an (0.35 conf)
authorized was authorized (0.47 conf)
unauthorized was unauthorized (0.50 conf)
absence was absence (0.41 conf)
made_transport_minor was were made to transport the minor for evaluation or (0.37 conf)
information_knowledge_belief was of my information knowledge and belief (0.30 conf)
signature_date was Date (1.00 conf)
undefined was undefined (0.38 conf)
users1_address_line_one was Address (1.00 conf)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
text__2 was Text3 (0.35 conf)
text__3 was Text4 (0.35 conf)
text__4 was Text5 (0.35 conf)
cas_e was CASE NO (0.47 conf)
hospitalization_mental_health__1 was hospitalization pursuant to Chapter 4A of the Mental Health Code (0.37 conf)
hospitalization_mental_health__2 was hospitalization pursuant to Chapter 4A of the Mental Health Code2 (0.42 conf)

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

PCM 240m, Petition Regarding Transport of Minor

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Identified Data Fields:

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