Form AOC-705A "Sheriff Transport and Examination Order (Involuntary Treatment-Substance Use Disorder)" - Kentucky

What Is Form AOC-705A?

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

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Kentucky Court of Justice;
  • 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 AOC-705A by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

ADVERTISEMENT
ADVERTISEMENT

Download Form AOC-705A "Sheriff Transport and Examination Order (Involuntary Treatment-Substance Use Disorder)" - Kentucky

Download PDF

Fill PDF online

Rate (4.6 / 5) 33 votes
Page background image
AOC-705A
Case No. ____________________
Rev. 6-19
Page 1 of 2
l e x
Court ________________________
District
e t
j u s t i t i a
Commonwealth of Kentucky
County ______________________
Court of Justice
www.courts.ky.gov
SHERIFF TRANSPORT AND
EXAMINATION ORDER
Division ______________________
KRS 222.435
(Involuntary Treatment-Substance Use Disorder)
IN THE INTEREST OF:
RESPONDENT_____________________________________________________
Residence: ____________________________________________
______________________________________________________
Current Location: _______________________________________
______________________________________________________
(
)
Telephone Number: ______________________________
WHEREAS, a Verified Petition requesting Involuntary Treatment for a Substance Use Disorder having been filed with the
Court; the Court having reviewed the allegations therein and having examined the Petitioner under oath; and it appearing to
the Court that there is probable cause to believe the Respondent should be ordered to undergo treatment for a substance
use disorder or there exists a substantial likelihood of such threat in the near future, and Respondent can reasonably
benefit from treatment; and the Court being otherwise sufficiently advised:
IT IS HEREBY ORDERED that:
1. The Respondent be delivered to __________________________________ (treatment/examination facility),
without unnecessary delay, by the Sheriff or other Peace Officer of this County, to be examined by a licensed
Physician and/or Qualified Health Professional.
2. Following said examination, the licensed Physician and/or Qualified Health Professional shall file a Certification
of findings with this Court.
3. The transportation costs of the sheriff, other peace officer, ambulance service, or other private agency on contract
with the Cabinet shall be included in the costs of treatment for a substance use disorder to be paid by the
Petitioner.
________________________________, 2______
____________________________________________
Date
Judge's Signature
____________________________________________
Judge's Name (please print)
Attorney's Address:
_______________________________________________
_______________________________________________
_______________________________________________
(
)
Telephone Number: ______________________________
****** Petitioner may be required to make any advanced payment necessary to execute this Order.
AOC-705A
Case No. ____________________
Rev. 6-19
Page 1 of 2
l e x
Court ________________________
District
e t
j u s t i t i a
Commonwealth of Kentucky
County ______________________
Court of Justice
www.courts.ky.gov
SHERIFF TRANSPORT AND
EXAMINATION ORDER
Division ______________________
KRS 222.435
(Involuntary Treatment-Substance Use Disorder)
IN THE INTEREST OF:
RESPONDENT_____________________________________________________
Residence: ____________________________________________
______________________________________________________
Current Location: _______________________________________
______________________________________________________
(
)
Telephone Number: ______________________________
WHEREAS, a Verified Petition requesting Involuntary Treatment for a Substance Use Disorder having been filed with the
Court; the Court having reviewed the allegations therein and having examined the Petitioner under oath; and it appearing to
the Court that there is probable cause to believe the Respondent should be ordered to undergo treatment for a substance
use disorder or there exists a substantial likelihood of such threat in the near future, and Respondent can reasonably
benefit from treatment; and the Court being otherwise sufficiently advised:
IT IS HEREBY ORDERED that:
1. The Respondent be delivered to __________________________________ (treatment/examination facility),
without unnecessary delay, by the Sheriff or other Peace Officer of this County, to be examined by a licensed
Physician and/or Qualified Health Professional.
2. Following said examination, the licensed Physician and/or Qualified Health Professional shall file a Certification
of findings with this Court.
3. The transportation costs of the sheriff, other peace officer, ambulance service, or other private agency on contract
with the Cabinet shall be included in the costs of treatment for a substance use disorder to be paid by the
Petitioner.
________________________________, 2______
____________________________________________
Date
Judge's Signature
____________________________________________
Judge's Name (please print)
Attorney's Address:
_______________________________________________
_______________________________________________
_______________________________________________
(
)
Telephone Number: ______________________________
****** Petitioner may be required to make any advanced payment necessary to execute this Order.
AOC-705A
Rev. 6-19
Page 2 of 2
EXECUTION
Executed by delivering the Respondent to:
________________________________________________________________________________________________
________________________________________________________________________________________________
_____________________________, 2_____
____________________________________________
Date
Signature/Title
Print
Reset Form
Distribution:
Original – Court File
Copy – Respondent’s Attorney
5 Copies – Peace Officer
1 - Respondent
2 - Peace Officer’s file and return
1 - Licensed Physician named above
1 - Qualified Health Professional named above
Page of 2