Form PCM241 "Notice of Right to Object to Hospitalization and Objection and Demand for Hearing" - Michigan

Form PCM241 or the "Notice Of Right To Object To Hospitalization And Objection And Demand For Hearing" is a form issued by the Michigan Probate Court.

Download a PDF version of the Form PCM241 down below or find it on the Michigan Probate Court Forms website.

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Download Form PCM241 "Notice of Right to Object to Hospitalization and Objection and Demand for Hearing" - Michigan

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PCS CODE: NRR
Approved, SCAO
TCS CODE: NRTO
STATE OF MICHIGAN
FILE NO.
NOTICE OF RIGHT TO
PROBATE COURT
OBJECT TO HOSPITALIZATION AND
COUNTY OF
OBJECTION AND DEMAND FOR HEARING
In the matter of
First, middle, and last name
1. On
, after a hearing required by statute, the court found you to be a person requiring
Date
treatment and entered an order for a program of alternative treatment.
2.
a. After being notified that
the alternative program was insufficient,
you did not comply with the alternative program,
the court entered an order (form PCM 217a) that resulted in your hospitalization and/or placement in a different
alternative treatment program. A copy of the amended order (form PCM 217a) is attached.
b. The court has been notified that you have been hospitalized by a psychiatrist's order under MCL 330.1474a.
NOTICE OF RIGHT TO OBJECT
TO:
You are notified that you may object to the court's or psychiatrist's order to hospitalize you by completing the objection below
and returning it to the court no later than 7 days after receiving this notice. The court will schedule a hearing within 10 days after
receiving your objection.
PROOF OF SERVICE
I certify that on
at
I personally served this notice on the individual named in the
Date
Time
Notice of Right to Object.
Date
Signature
OBJECTION TO HOSPITALIZATION AND DEMAND FOR HEARING
I object to my hospitalization and demand a hearing.
I request court-appointed legal counsel.
Date
Signature
Name (type or print)
Do not write below this line - For court use only
MCL 330.1475a, MCR 5.744
NOTICE OF RIGHT TO OBJECT TO HOSPITALIZATION AND OBJECTION AND DEMAND FOR HEARING
PCM 241 (9/16)
PCS CODE: NRR
Approved, SCAO
TCS CODE: NRTO
STATE OF MICHIGAN
FILE NO.
NOTICE OF RIGHT TO
PROBATE COURT
OBJECT TO HOSPITALIZATION AND
COUNTY OF
OBJECTION AND DEMAND FOR HEARING
In the matter of
First, middle, and last name
1. On
, after a hearing required by statute, the court found you to be a person requiring
Date
treatment and entered an order for a program of alternative treatment.
2.
a. After being notified that
the alternative program was insufficient,
you did not comply with the alternative program,
the court entered an order (form PCM 217a) that resulted in your hospitalization and/or placement in a different
alternative treatment program. A copy of the amended order (form PCM 217a) is attached.
b. The court has been notified that you have been hospitalized by a psychiatrist's order under MCL 330.1474a.
NOTICE OF RIGHT TO OBJECT
TO:
You are notified that you may object to the court's or psychiatrist's order to hospitalize you by completing the objection below
and returning it to the court no later than 7 days after receiving this notice. The court will schedule a hearing within 10 days after
receiving your objection.
PROOF OF SERVICE
I certify that on
at
I personally served this notice on the individual named in the
Date
Time
Notice of Right to Object.
Date
Signature
OBJECTION TO HOSPITALIZATION AND DEMAND FOR HEARING
I object to my hospitalization and demand a hearing.
I request court-appointed legal counsel.
Date
Signature
Name (type or print)
Do not write below this line - For court use only
MCL 330.1475a, MCR 5.744
NOTICE OF RIGHT TO OBJECT TO HOSPITALIZATION AND OBJECTION AND DEMAND FOR HEARING
PCM 241 (9/16)
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