Affidavit To Accompany Petition For Transport And Or Temporary Detention {PC 109}

Form PC 109 - AFFIDAVIT TO ACCOMPANY PETITION FOR TRANSPORT AND/OR TEMPORARY DETENTION. This form is used in the State of Michigan by the Judicial Circuit - Family Division when a person is believed to be a carrier of an infectious agent or serious communicable disease and poses a health threat to others. This affidavit provides sworn information supporting a petition for an emergency court order to authorize the individual’s transport to, and/or temporary detention in, an emergency care or treatment facility. The form requires the affiant to state the reasons for believing the individual is infected, explain why they present a public health risk, and identify the services needed at a treatment facility. It also allows the affiant to request an emergency order by describing urgent circumstances. Approved, SCAO. MCL 333.5207(1),(2), MCR 3.614. www.FormsWorkflow.com