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Notification Of Noncompliance And Request For Modified Order PCM 230 - Michigan
| Notification Of Noncompliance And Request For Modified Order Form. This is a Michigan form and can be used in Mental Health Statewide . |
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Approved, SCAO OSM CODE: NCA STATE OF MICHIGAN FILE NO. PROBATE COURT NOTIFICATION OF NONCOMPLIANCE COUNTY AND REQUEST FOR MODIFIED ORDER CIRCUIT COURT - FAMILY DIVISION In the matter of 1. I, , make this notification as the Name (type or print) agency. mental health professional who is supervising the individuals alternative treatment program. individual. 2. The individual who is the subject of this notification was ordered to undergo a program of alternative treatment or combined hospitalization and alternative treatment. a. The 90 day order for alternative treatment has not been or will not be sufficient to prevent the individual from inflicting harm or injuries to self or others. b. The one year order for alternative treatment has not been or will not be sufficient to prevent the individual from inflicting harm or injuries to self or others. c. The individual is not complying with the order. d. I believe that my alternative treatment program is not appropriate. 3. There remains days of hospitalization under the last order. The individual needs immediate hospitalization.4. This conclusion is based upon a. my personal observation of the individual doing the following acts and saying the following things: state the conduct and statements and the name, b. conduct and statements seen or heard by others and related to me: address, and telephone number of each witness. 5. A psychiatrist has ordered the individual to return to the hospital. 6. I request the court to modify its last order to direct the individual a. to undergo another alternative treatment program. b. to undergo hospitalization or combined hospitalization and alternative treatment, with hospitalization not to exeed days. c. to be transported to the hospital by a peace officer if the individual refuses to comply with the psychiatrists order to return to the hospital. Date Signature Title Business address Agency City, state, zip Telephone no. Do not write below this line - For court use only MCL 330.1475; MSA 14.800(475), MCR 5.744(B)PCM 230 (9/97) NOTIFICATION OF NONCOMPLIANCE AND REQUEST FOR MODIFIED ORDER
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