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Summary Of Substance Abuse Assessment Report MC 212 - Michigan

Summary Of Substance Abuse Assessment Report Form. This is a Michigan form and can be used in Motor Vehicle Offenses Statewide .
 Fillable pdf Last Modified 7/7/2005
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Original - Court Approved, SCAO 1st copy - Agent STATE OF MICHIGAN CASE NO. JUDICIAL DISTRICT SUMMARY OF JUDICIAL CIRCUIT SUBSTANCE ABUSE ASSESSMENT REPORT Court address Court telephone no.1. The defendant, : Name a. was evaluated by this agency on . Date b. failed to report for evaluation. 2. This agency recommends that the defendant: a. will not benefit from substance abuse service. b. will benefit from the services specified below. Participation should co ntinue for . Period of time Alcohol Highway Safety Education (AHSE) Treatment services: outpatient inpatient residential mental health 3. Comments: 4. Suggested providers: To be completed on direction of court. TYPE OF SERVICE AREA AGENCY(IES) PROVIDING SERVICE AHSE, Outpatient, Inpatient, Name, address, and telephone number Residential or Mental Health CONFIDENTIAL INFORMATION - NOT TO BE KEPT IN LEGAL CASE FILE Agency Signature Address Title City, state, zip Telephone no. Date American LegalNet, Inc.MC 212 (6/99) SUMMARY OF SUBSTANCE ABUSE ASSESSMENT REPORT www.USCourtForms.com
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