Consent To Treatment {CC-DC-CR 109}

CC-DC-CR-109 - CONSENT TO TREATMENT. This form is used in the Circuit Court or District Court of Maryland when a criminal defendant agrees to participate in a court-ordered treatment program, often as a condition of probation or in connection with a deferred sentencing arrangement. By signing this form, the defendant voluntarily consents to undergo treatment at a designated facility or program recommended by the Maryland Department of Health. The defendant also agrees to comply with all requirements of the treatment plan, including completing any residential or outpatient programs and adhering to the terms of any probation order and after-care plan established as part of their case. The form authorizes the disclosure of the defendant’s protected health information related to evaluation, treatment, and counseling. This information may be shared with the court, the Maryland Department of Health, pretrial services, the Division of Parole and Probation, and any other specified agencies involved in monitoring the defendant’s progress. The defendant acknowledges that failure to meet the conditions of treatment or probation could result in the imposition of a previously suspended sentence. www.FormsWorkflow.com