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Approved SCAO STATE OF MICHIGAN PROBATE COURT COUNTY OF JIS CODE SPA SUPPLEMENTAL PETITION TO APPLICATION FOR HOSPITALIZATION AND ORDER FOR EXAMINATION FILE NO. In the matter of PETITION 1. I executed the attached Application for Hospitalization PCM 201. I have been unable to have the individual examined by a physician or licensed psychologist although I have made the following efforts 2. Approved SCAO STATE OF MICHIGAN PROBATE COURT COUNTY OF JIS CODE SPA SUPPLEMENTAL PETITION TO APPLICATION FOR HOSPITALIZATION AND ORDER FOR EXAMINATION FILE NO. In the matter of PETITION 1. I executed the attached Application for Hospitalization PCM 201. I have been unable to have the individual examined by a physician or licensed psychologist although I have made the following efforts 2. I request the court to order a* the individual to be examined at the preadmission screening unit designated by the community mental health services program* b. a peace officer to take the individual into protective custody and transport him/her to the preadmission screening unit named above for the examination* I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my information knowledge and belief* Date Signature of petitioner Attorney name type or print Bar no. Address City state zip Name type or print Telephone no. ORDER THE COURT FINDS 3. The application is is not reasonable and in full compliance with section 424 of the Mental Health Code. 4. A reasonable effort was was not made to secure an examination* 5. It is necessary that a peace officer take the individual into protective custody and immediately transport him or her to the designated preadmission screening unit for the examination* 6. There does not appear to be probable cause to take action on this petition* IT IS ORDERED 7. The individual be examined at the designated preadmission screening unit. preadmission screening unit provided that the individual is presented for examination by which is within 10 days of the date of execution of the application* 9. The petition is denied* Judge USE NOTE If this form is being filed in the circuit court family division please enter the court name and county in the upper left-hand corner of the form* Do not write below this line - For court use only MCL 330. In the matter of PETITION 1. I executed the attached Application for Hospitalization PCM 201. I have been unable to have the individual examined by a physician or licensed psychologist although I have made the following efforts 2. I request the court to order a* the individual to be examined at the preadmission screening unit designated by the community mental health services program* b. I request the court to order a* the individual to be examined at the preadmission screening unit designated by the community mental health services program* b. a peace officer to take the individual into protective custody and transport him/her to the preadmission screening unit named above for the examination* I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my information knowledge and belief* Date Signature of petitioner Attorney name type or print Bar no.

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Keywords relevant to Pcm 201

  • hospitalization
  • Petitioner
  • Probate
  • supplemental
  • Penalties
  • compliance
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