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Here is the text we could read:

 
Name 
 
Address 
 
City, State, Zip 
 
Phone 

 
Email  

 

 

 
 
 
 
 
 

 
Check your email. You will receive information and 
documents at this email address.  
 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the matter of essential treatment for 

Order on Request for Examination 
(Utah Code 62A-15-1205) 

_____________________________________ 
Respondent 

_______________________________ 
Case Number 

_______________________________ 
Judge  

The matter before the court is the petitioner’s request for an examination in support of 
the Petition for Essential Treatment and Intervention.  

Having considered the documents filed with the court,  

The court orders: 

1. 

The assertions in the Petition for Essential Treatment and Intervention, if true,  

[  ]    are sufficient to order the respondent to undergo essential treatment. 

[  ]  are not sufficient to order the respondent to undergo essential treatment. 

The petition is dismissed. 

2. 

[  ]  Respondent shall be examined by two essential treatment examiners to 

determine:  

  whether the respondent meets each of the criteria described in Section 

62A-15-1204;  
the severity of the respondent's substance use disorder, if any;  

 

Order on Request for Examination 

Page 1 of 3 

1002ICF Approved October 17, 2017 / 
Revised May 1, 2019 
 

 

  what forms of treatment would substantially benefit the respondent, if the 
examiner determines that the respondent has a substance use disorder; 
and  
the appropriate duration for essential treatment, if essential treatment is 
recommended. 

 

3. 

[  ]  The essential treatment examiners shall certify their findings to the court 

within 24 hours after the examination has been completed. The examination 
must be completed before the evidentiary hearing. 

4. 

[  ]  The examinations are scheduled as follows: 

Examination one 

Date: _______________ 

Time: ______________  [  ] a.m.  [  ]  p.m. 

Examiner’s name: ______________________________________________ 

Facility name: _________________________________________________ 

Address: ____________________________________________________ 

Examination two 

Date: _______________ 

Time: ______________  [  ] a.m.  [  ]  p.m. 

Examiner’s name: ______________________________________________ 

Facility name: _________________________________________________ 

Address: ____________________________________________________ 

5. 

[  ]  An evidentiary hearing will be held to determine whether the court should 
order the respondent to undergo essential treatment for a substance use 
disorder. The hearing will be held on: 

Date: _______________ 

Time: ______________  [  ] a.m.  [  ]  p.m. 

Room: ______________ 

Judge: ___________________________________ 

Courthouse address: _______________________________________________ 

  Respondent has the right to be represented by an attorney at their own 

expense. 

1002ICF Approved October 17, 2017 / 
Revised May 1, 2019 
 

Order on Request for Examination 

Page 2 of 3 

 

  Respondent may request a preliminary hearing before submitting to the 

examination. 

6. 

[  ]  Other: 

udge’s signature may instead appear at the top of the first page of this document. 

 

Signature ► 

 

 

Judge 

I certify that emailed or mailed a copy of this Order on Request for Examination on the following people. 

Clerk’s Certificate of Mailing 

Name 

Address 

Date 

 

 

 

 

 

 

Respondent’s Guardian (if any)) 

Clerk’s 
Signature ► 

Printed Name 

 

 

1002ICF Approved October 17, 2017 / 
Revised May 1, 2019 
 

Order on Request for Examination 

Page 3 of 3 

 

    J

             

 
Date 

Petitioner) 

Respondent) 

    (

    (

    (

 
Date

Order on Request for Examination (Utah Code 62A-15-1205)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah 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 legacy.utcourts.gov (2023-03)
Page(s): 3
Fields(s): 144
Average fields per page: 48
Reading Level: Grade 13
LIST Grouping(s): GO-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.

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

Order on Request for Examination (Utah Code 62A-15-1205)

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

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