Form PCM214 "Initial Order After Hearing on Petition for Mental Health Treatment" - Michigan

What Is Form PCM214?

This is a legal form that was released by the Michigan Probate Court - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the Michigan Probate Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PCM214 by clicking the link below or browse more documents and templates provided by the Michigan Probate Court.

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Download Form PCM214 "Initial Order After Hearing on Petition for Mental Health Treatment" - Michigan

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PCS CODE: OHA/OAO
Approved, SCAO
TCS CODE: OFH/OAO
STATE OF MICHIGAN
FILE NO.
INITIAL ORDER AFTER
PROBATE COURT
HEARING ON PETITION FOR
COUNTY OF
MENTAL HEALTH TREATMENT
In the matter of
First, middle, and last name
Court ORI
Date of birth
Place of birth
Race
Sex
Current address of individual
1. Date of Hearing:
Judge:
Bar no.
2. A petition has been filed by
asserting that the individual named
Petitioner name (type or print)
above is a person requiring treatment.
THE COURT FINDS:
3. Notice of hearing has been given according to law.
4. The individual
was present in court.
was not present for reasons stated on the record.
The hearing was
with
without a jury.
Present were:
, attorney for the individual, and
, attorney for the petitioner.
5. Testimony of a physician, psychiatrist, or licensed psychologist was waived by the individual and the individual's attorney.
6.
Testimony was given by
.
Testimony was not given because the parties stipulated to entry of the order.
7. By clear and convincing evidence, the individual is a person requiring treatment because the individual has a mental illness,
a. and as a result of that mental illness can reasonably be expected within the near future to intentionally or unintentionally
seriously physically injure self or others, and has engaged in an act or acts or made significant threats that are
substantially supportive of this expectation.
b. and as a result of that mental illness is unable to attend to those basic physical needs that must be attended to in
order to avoid serious harm in the near future, and has demonstrated that inability by failing to attend to those basic
physical needs.
c. whose judgment is so impaired by that mental illness and whose lack of understanding of the need for treatment
has caused him or her to demonstrate an unwillingness to voluntarily participate in or adhere to treatment that is
necessary, on the basis of competent clinical opinion, to prevent a relapse or harmful deterioration of his or her
condition, and presents a substantial risk of significant physical or mental harm to the individual or others.
8. There
is
is not
an available treatment program that is an alternative to hospitalization or that follows an
initial period of hospitalization adequate to meet the individual's treatment needs and is sufficient to prevent harm that the
individual may inflict upon self or others within the near future.
9.
hospital can provide treatment,
which is adequate and appropriate to the individual’s condition.
10. The individual is not a person requiring treatment.
(SEE SECOND PAGE)
Do not write below this line - For court use only
MCL 330.1401, MCL 330.1464a, MCL 330.1465, MCL 330.1468, MCL 330.1469a, MCL 330.1470,
INITIAL ORDER AFTER HEARING ON PETITION FOR MENTAL HEALTH TREATMENT
PCM 214 (12/19)
MCL 330.1472a(1)
PCS CODE: OHA/OAO
Approved, SCAO
TCS CODE: OFH/OAO
STATE OF MICHIGAN
FILE NO.
INITIAL ORDER AFTER
PROBATE COURT
HEARING ON PETITION FOR
COUNTY OF
MENTAL HEALTH TREATMENT
In the matter of
First, middle, and last name
Court ORI
Date of birth
Place of birth
Race
Sex
Current address of individual
1. Date of Hearing:
Judge:
Bar no.
2. A petition has been filed by
asserting that the individual named
Petitioner name (type or print)
above is a person requiring treatment.
THE COURT FINDS:
3. Notice of hearing has been given according to law.
4. The individual
was present in court.
was not present for reasons stated on the record.
The hearing was
with
without a jury.
Present were:
, attorney for the individual, and
, attorney for the petitioner.
5. Testimony of a physician, psychiatrist, or licensed psychologist was waived by the individual and the individual's attorney.
6.
Testimony was given by
.
Testimony was not given because the parties stipulated to entry of the order.
7. By clear and convincing evidence, the individual is a person requiring treatment because the individual has a mental illness,
a. and as a result of that mental illness can reasonably be expected within the near future to intentionally or unintentionally
seriously physically injure self or others, and has engaged in an act or acts or made significant threats that are
substantially supportive of this expectation.
b. and as a result of that mental illness is unable to attend to those basic physical needs that must be attended to in
order to avoid serious harm in the near future, and has demonstrated that inability by failing to attend to those basic
physical needs.
c. whose judgment is so impaired by that mental illness and whose lack of understanding of the need for treatment
has caused him or her to demonstrate an unwillingness to voluntarily participate in or adhere to treatment that is
necessary, on the basis of competent clinical opinion, to prevent a relapse or harmful deterioration of his or her
condition, and presents a substantial risk of significant physical or mental harm to the individual or others.
8. There
is
is not
an available treatment program that is an alternative to hospitalization or that follows an
initial period of hospitalization adequate to meet the individual's treatment needs and is sufficient to prevent harm that the
individual may inflict upon self or others within the near future.
9.
hospital can provide treatment,
which is adequate and appropriate to the individual’s condition.
10. The individual is not a person requiring treatment.
(SEE SECOND PAGE)
Do not write below this line - For court use only
MCL 330.1401, MCL 330.1464a, MCL 330.1465, MCL 330.1468, MCL 330.1469a, MCL 330.1470,
INITIAL ORDER AFTER HEARING ON PETITION FOR MENTAL HEALTH TREATMENT
PCM 214 (12/19)
MCL 330.1472a(1)
Initial Order After Hearing on Petition for Mental Health Treatment (12/19)
File No.
IT IS ORDERED:
11. The individual shall be hospitalized for up to 60 days with no assisted outpatient treatment.
12. The individual shall receive combined hospitalization and assisted outpatient treatment for no longer than 180 days.
The individual shall be hospitalized for up to 60 days of the 180-day assisted outpatient treatment period.
An initial hospitalization period shall be up to
days.
1 to 60 days
13. The individual shall receive assisted outpatient treatment for no longer than 180 days.
14. Any hospitalization of the individual for mental health treatment shall occur in the hospital listed in item 9.
15. Any assisted outpatient treatment services shall be supervised by
.
Community mental health services or other designated entity
The following assisted outpatient services are ordered:
case management plan
case management services
all services recommended by the treatment provider
medication
blood or urinalysis tests to determine compliance with or effectiveness of prescribed medication
individual therapy
group therapy
individual and group therapy
day programs
partial day programs
educational training
vocational training
supervised living
assertive community treatment team services
substance use disorder treatment
substance use disorder testing (for individuals with a history of alcohol or substance use and for whom testing is
necessary to assist the court in ordering treatment designed to prevent deterioration)
any other services prescribed to treat the individual’s mental illness and either to assist the individual in living and
functioning in the community or to help prevent a relapse or deterioration that may reasonably be predicted to result in
suicide or the need for hospitalization. Those services are:
16. If the individual refuses to comply with a psychiatrist's order for hospitalization, a peace officer shall take the individual
into protective custody and transport the individual to the hospital designated by the psychiatrist.
17. If item 11 or 12 is checked, the Michigan State Police shall immediately enter the individual's identifying information
in this court order on LEIN.
18. If felony charges have been previously dismissed under MCL 330.2044(1)(b) and the time for petitioning to refile charges
has not elapsed, not less than 30 days before the scheduled release or discharge:
a. the director of the treating facility shall notify the prosecutor's office in the county in which charges against the person
were originally brought that the patient's release or discharge is pending.
b. the patient to be released or discharged shall undergo a competency examination as described in MCL 330.2026. A copy
of the written report of the examination along with the notice required in item 18a above shall be submitted to the
prosecutor's office in the county in which the charges against the patient were originally brought. The written report is
admissible as provided in MCL 330.2030(3).
19. The petition is
denied on the merits.
dismissed.
withdrawn.
Date
Judge
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