Order And Report On Alternative Mental Health Treatement {PCM 216} | Pdf Fpdf Docx | Michigan

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Order And Report On Alternative Mental Health Treatement {PCM 216} | Pdf Fpdf Docx | Michigan

Order And Report On Alternative Mental Health Treatement {PCM 216}

This is a Michigan form that can be used for Mental Health within Statewide.

Alternate TextLast updated: 1/8/2020

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In the matter of First, middle, and last name en-USIT IS ORDEREDen-US that en-USName (type or print)en-US shall prepare a report assessing the currenten-USavailability and appropriateness of alternatives to hospitalization for the individual named above including alternatives availableen-USfollowing an initial period of court-ordered hospitalization.en-USThe report shall be made to the court before the hearing on en-USDate and time of hearingen-US for en-USPetition for 60-day order, discharge, etc.en-US . en-USDate þ Judge þ Bar no. 1. þ I, en-USNameen-US , as en-USProfession, organization, and positionen-US , report as follows. 2. þ I have reviewed, as to their availability in or near the individual222s home community, treatment resources alternative to þ hospitalization and report as follows: en-US(If practical, give name of agency, program, etc.) þ a. þ Independent mental health professional: en-US þ þ en-US þ b. þ Community mental health day treatment, aftercare service, work activity, or other program: en-US þ en-US þ en-US þ en-US þ c. þ Substance abuse, rehabilitation service, or similar program of public or private agency: en-US þ en-US þ d. þ Other: en-US þ en-US þ en-US en-USORDER en-USREPORT ON EVALUATION OF HOSPITAL TREATMENT AND/OR ALTERNATIVE PROGRAMS American LegalNet, Inc. www.FormsWorkFlow.com File No. 3. þ I have reviewed, as to their availability in or near the individual's home community, residential accommodations and report þ as follows: en-US(If practical, give name of residence, location, etc.) þ a. þ Independent: en-USIndividual222s own house, apartment, etc. þ b. þ Residence of relative or friend: en-US þ c. þ Foster care home: en-US þ en-US þ d. þ Nursing home: en-US þ e. þ Other: en-US þ en-US þ 4. þ I recommend release. þ þ 5. þ I recommend a course of treatment of þ þ hospitalization þ þ hospitalization for en-US en-US days, followed by þ assisted outpatient treatment as follows: þ en-US þ en-US 6. þ My recommendation is based upon the following described interviews, observations, and information: þ en-US þ en-US þ en-US þ en-US 7. þ I believe the hospital to which admission is proposed þ þ can þ þ cannot þ provide its prescribed treatment program þ þ appropriately and adequately because en-US þ en-US 8. þ I recommend the following agency or independent mental health professional to supervise the outpatient treatment: þ Name þ Complete address þ þ The agency or professional þ has þ has not þ indicated capability and willingness to supervise the recommended program. 9. þ The individual currently has the following source(s) of funds to cover his or her care in the community: þ en-US þ þ þ þ þ þ þ þ þ þ þ þ þ þ a. þ Application for supplemental funds has been made. They should be available en-US en-US . þ þ b. þ Application for supplemental funds has not been made because en-US en-US . þ Application will be made on en-US en-US and should be available about en-US en-US . þ c. þ Pending receipt of supplemental funds, the following funds will be available: þ þ Direct relief. þ þ MDHHS/CMH emergency care funds. þ þ Other assistance: en-US þ þ None. Reason: en-US en-USDate þ en-USSignature American LegalNet, Inc. www.FormsWorkFlow.com

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