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Order For Involuntary Medication And Treatment ME-905 - Wisconsin
| Order For Involuntary Medication And Treatment Form. This is a Wisconsin form and can be used in Medical Circuit Court Statewide . |
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COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. FORM SUMMARY : : _______________________________________________________________________________ Calendar No. Index No. Name of Forms: Order for Involuntary Medication and Treatment Plaintiff(s) : JUDICIAL SUBPOENA Form Number: ME-905 -against: _______________________________________________________________________________ Statutory Reference: Benchbook Reference: Purpose of Form: §51.61(1)(g), Wisconsin Statutes MH 2-17 : : Defendant(s) : ...................................................... Authorizes a treatment provider to involuntarily administer medications (including psychotropic medications) and treatment to a subject. The Committee anticipates this form can be completed in court by checking the appropriate box. Original to court; copies to parties, counsel and treatment providers THE PEOPLE OF THE STATE OF NEW YORK Who Completes It: TO Distribution of Form: Accompanying Forms: GREETINGS: Generally this form will be attached to an order of detention after a finding all business and excuses order for aside, you and WE COMMAND YOU, thatof probable cause, or an being laid commitment. each of you attend before , the Honorable at the Court located at last update 06/00. County of New Form/Modification: Modifications, in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and givefindings section, reformatted and reworded options a. and b. evidence as a witness in this action on the part of the Modifications: In the and eliminated option c. Changed caption under signature line from "Court Commissioner" to "Circuit Court Commissioner". Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Comments: whose behalf this subpoena was comments a maximum penalty of previous all damages sustained as a The following issued for are retained from the $50 and form the party on result of your failure to comply. summary: Witness, Honorable The court can enter an order allowing a treatmentof the Justices of the , one provider to Court in County,administerof day involuntary medication or treatment to a subject after a , 20 finding of probable cause, at a final commitment hearing, or upon a separate post-commitment petition and hearing. If the order is entered following a finding of probable cause, the order is in effect only until the final hearing. Otherwise, the order would be in effect until the commitment expires or the order is Attorney(s) for vacated. About this form: (Attorney must sign above and type name below) This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Office and P.O. Address Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 12/16/02 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : STATE OF WISCONSIN, CIRCUIT COURT, Index No. COUNTY For Official Use : IN THE MATTER OF THE CONDITION OF Plaintiff(s) Name of Subject Order for Involuntary Medication:and Treatment SUBPOENA JUDICIAL : Calendar No. -againstCase No. Date of Birth : : THE COURT FINDS AND CONCLUDES: Defendant(s) 1. The issue of involuntary administration of medication or treatment:was considered at a hearing: ...................................................... a. at or after a probable cause hearing. There is probable cause to believe that medication or treatment will have therapeutic value and will not unreasonably impair the subject's ability to prepare for and participate in future court proceedings. THE PEOPLE OF THE STATE OF NEW YORK b. at or after a final hearing. Medication or treatment will have therapeutic value. TO 2. The subject appeared in person. by counsel. 3. The subject needs medication or treatment. GREETINGS: 4. The advantages, disadvantages, and alternatives to medication have been explained to the subject. 5. the Honorable Due to: , at the Court mental located at County of illness, developmental disability, in room , on the day of , 20 , at o'clock in the noon, and at any recessed alcoholism, or adjourned date, to testify and give evidence as a witness in this action on the part of the drug dependence, the subject is not competent to refuse psychotropic medication or treatment because: the subject is incapable of expressing an understanding of the advantages and disadvantages of accepting medication or treatment and the alternatives; or, the Your failure to comply incapablesubpoena is punishable as a contempt of court anddisadvantages liable to subject is substantially with this of applying an understanding of the advantages, will make you the party on whose behalf this her condition inissued to make an informed choice as to whether to accept or and alternatives to his or subpoena was order for a maximum penalty of $50 and all damages sustained as a result refuse psychotropic medications. of your failure to comply. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before THE COURT ORDERS: Court in Witness, Honorable County, , one of the Justices of the day of , 20 Medication and treatment may be administered to the subject, regardless of his or her consent: until the final hearing in this matter. (Attorney during the period of commitment, or until further order of the court.must sign above and type name below) BY THE COURT: Distribution: 1. Court Original 2. Parties 3. Treatment Provider Attorney(s) for Circuit Court Judge/Circuit Court Commissioner Office and Name Printed or Typed P.O. Address Date Telephone No.: Facsimile No.: E-Mail Address: ME-905, 12/02 Order for Involuntary Medication and Treatment § 51.61(1)(g), Wisconsin Statutes Mobile Tel. No.: This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.USCourtForms.com
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