Objection To Hospitalization Of Minor {PCM 202}

Approved, SCAO OSM CODE: OBH STATE OF MICHIGAN FILE NO. PROBATE COURT OBJECTION TO HOSPITALIZATION COUNTY OF A MINOR CIRCUIT COURT - FAMILY DIVISION In the matter of , a minor1. I object to the hospitalization of this minor and request the court to schedule a hearing on this objection. Date Signature 1. The person filing this objection is: Name and is the minor patient, who is 14 years of age or older. the minors parent, guardian, or person in loco parentis. The request for hospitalization was made by the minor or a peace officer. a person designated by the court. was admitted 2. The minor is years old, and is scheduled for admission to upon the application of Address City State Zip Telephone no. who is the minors parent, guardian, person in loco parentis, i.e. other, i.e. 3. The minor received a periodic review of the minors suitability for continued hospitalization on . Date 4. The reason for this objection is: Do not write below this line - For court use only PCM 202 (9/97) OBJECTION TO HOSPITALIZATION OF A MINOR MCL 330.1498m; MSA 14.800(498m), MCR 5.742