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Notice of Right To Appeal Return And Appeal Of Return From Authorized Leave PCM 233 - Michigan
| Notice of Right To Appeal Return And Appeal Of Return From Authorized Leave Form. This is a Michigan form and can be used in Mental Health Statewide . |
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Approved, SCAO OSM CODE: NRA STATE OF MICHIGAN NOTICE OF RIGHT TO APPEAL RETURN FILE NO. PROBATE COURT AND APPEAL OF RETURN COUNTY FROM AUTHORIZED LEAVE CIRCUIT COURT - FAMILY DIVISION In the matter of The above individual has been on authorized leave from a hospital or center for more than 10 days. The individual was then returned to the hospital or center involuntarily, as follows: Date of last order Date of return Time of return Age of individual Name of hospital/center NOTICE OF RIGHT TO APPEAL You have a right to appeal your return to the hospital or center and have a hearing to determine the appeal. If you wish to appeal, notify the Court within 7 days after receipt of this notice. Complete the the petition below and send a copy to the court. In the case of a child less than 13 years of age, the appeal must be made by the the parent or guardian. PROOF OF SERVICE I certify that this notice was personally served on the above individual on Date at Time ,and a copy was mailed to Court on . Date Signature NOTE TO COURT: MCR 5.743 and 5.743b requires form PCM 227 be sent to the individuals attorney. PETITION APPEALING RETURN TO HOSPITAL I appeal my return to the hospital/center and demand a hearing. I request court appointed legal counsel. I declare that this petition for appeal has been examined by me and that its contents are true to the best of my information, knowledge, and belief. individual parent Date Signature guardian Do not write below this line - For court use only MCL 330.1408(3); MSA 14.800(408)(3), MCL 330.1537(3); MSA 14.800(537)(3), MCR 5.743, MCR 5.743a, MCR 5.743bPCM 233 (9/97) NOTICE OF RIGHT TO APPEAL RETURN AND APPEAL OF RETURN FROM AUTHORIZED LEAVE
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