Michigan > Statewide > Mental Health
Demand For Hearing PCM 236 - Michigan
| Demand For Hearing Form. This is a Michigan form and can be used in Mental Health Statewide . |
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Approved, SCAO JIS CODE: DFH STATE OF MICHIGAN PROBATE COURT COUNTY OF In the matter of FILE NO. DEMAND FOR HEARING 1. I am the individual, and I demand a court hearing. 2. I am the hospital director/designee, alternative treatment provider/designee, and I demand a court hearing because the individual refuses to accept prescribed treatment. the individual orally demanded a hearing. 3. I am the executive director of the community mental health services program. The individual deferred the initial hearing and is participating in an alternative treatment program in the community. The deferral period ends on . Date I believe s/he continues to require treatment, but s/he refuses to sign a voluntary treatment form, and I demand a court hearing. I believe s/he continues to require treatment, but s/he is found not suitable for voluntary treatment, and I demand a court hearing. 4. I am the director of the hospital where the individual has remained hospitalized since deferring the initial hearing on . I believe the individual continues to require treatment and Date will not agree to sign a formal voluntary admission, and I demand a court hearing. is not suitable for voluntary admission, and I demand a court hearing. 5. The individual requires hospitalization pending the hearing and it is necessary that the court order a peace officer to transport the individual to the 6. The individual is located at . Date Signature Name (type or print) Address City, state, zip Telephone no. hospital pending the hearing. (Complete only if item 5 is checked.) ORDER Judge: Bar no. 1. Date of hearing: 2. A peace officer shall take the individual into protective custody and transport him/her to the hospital stated above. Signature USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form. Do not write below this line - For court use only PCM 236 (9/11) DEMAND FOR HEARING American LegalNet, Inc. www.FormsWorkFlow.com MCL 330.1455(5), (7)-(10)
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