Form PC665 "Order for Placement of Individual With Developmental Disability" - Michigan

What Is Form PC665?

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 September 1, 2007;
  • 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 PC665 by clicking the link below or browse more documents and templates provided by the Michigan Probate Court.

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Download Form PC665 "Order for Placement of Individual With Developmental Disability" - Michigan

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Approved, SCAO
JIS CODE: OPI
FILE NO.
STATE OF MICHIGAN
ORDER FOR PLACEMENT OF
PROBATE COURT
INDIVIDUAL WITH
COUNTY
DEVELOPMENTAL DISABILITY
CIRCUIT COURT - FAMILY DIVISION
In the matter of
, an individual with a developmental disability
1. Date of hearing:
Judge:
Bar no.
2. The guardian has filed a petition requesting authority to execute an application for admission of the individual to a facility.
THE COURT FINDS:
3. Notice of hearing was given to or waived by all interested persons.
4.
is the guardian of the person for the individual named above.
Name
5. From testimony given in open court and from the report and evaluation filed with the court, the individual requires care and
services at
.
Name of facility
6. The placement offers appropriate treatment and residential programs to meet the individual's need.
7. There appears to be no less restrictive treatment and residential program available to meet the individual's needs.
IT IS ORDERED:
8. The guardian is authorized to execute the necessary application for the
temporary administrative admission not to exceed 30 days
administrative admission
admission
of the individual named above to
.
Name of facility
Date
Judge
Do not write below this line - For court use only
ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY
MCL 330.1623, MCR 5.746(B)
PC 665 (9/07)
Approved, SCAO
JIS CODE: OPI
FILE NO.
STATE OF MICHIGAN
ORDER FOR PLACEMENT OF
PROBATE COURT
INDIVIDUAL WITH
COUNTY
DEVELOPMENTAL DISABILITY
CIRCUIT COURT - FAMILY DIVISION
In the matter of
, an individual with a developmental disability
1. Date of hearing:
Judge:
Bar no.
2. The guardian has filed a petition requesting authority to execute an application for admission of the individual to a facility.
THE COURT FINDS:
3. Notice of hearing was given to or waived by all interested persons.
4.
is the guardian of the person for the individual named above.
Name
5. From testimony given in open court and from the report and evaluation filed with the court, the individual requires care and
services at
.
Name of facility
6. The placement offers appropriate treatment and residential programs to meet the individual's need.
7. There appears to be no less restrictive treatment and residential program available to meet the individual's needs.
IT IS ORDERED:
8. The guardian is authorized to execute the necessary application for the
temporary administrative admission not to exceed 30 days
administrative admission
admission
of the individual named above to
.
Name of facility
Date
Judge
Do not write below this line - For court use only
ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY
MCL 330.1623, MCR 5.746(B)
PC 665 (9/07)