Order To Report To Residential Treatment Center Pursuant TO DOSA Sentence {CR 84.0497}

Superior Court of Washington County of No. State of Washington, Plaintiff, v. _____________________________________, Defendant. DOB: CCN: Order to Report to Residential Treatment Center Pursuant to DOSA Sentence (ORTDOSA) The court sentenced the defendant pursuant to the Residential DOSA Option. The court orders the defendant to report as follows: Date: Time: ___________________________________________________________ 8 a.m. to 5 p.m. unless other arrangements have been made. [ ] ABHS 12715 E. Mission Avenue Spokane Valley, Washington 99216 Location: [ ] ABHS 500 SE Washington Avenue Chehalis, Washington 98532 ABHS: Phone 866-729-8083 (toll free); Fax: 509-242-1867; email: snorris@abhsinc.net The Defendant must be drug and alcohol free upon report to the treatment center. The Defendant shall follow all rules of the treatment agency including the attached rules for reporting to treatment. Dated this _______ day of _______________________, 20____. ______________________________________ Judge/Print Name; Presented by: ___________________________ Deputy Prosecuting Attorney WSBA No. Print Name: Attorney for Defendant WSBA No. Print Name: ___________________________ Defendant Print Name: Or Rept to Res. Treatment Center (ORTDOSA) - Page 1 of 1 CR 84.0497 (12/2009) RCW 9.94A.660 American LegalNet, Inc. www.FormsWorkFlow.com