Form Pcm 209 Michigan PDF Details

In navigating the complexities of mental health and legal systems, the PCM 209 Michigan form emerges as a critical document, intertwining legal procedures with healthcare needs. This form serves as a supplemental petition to an initial application for hospitalization (PCM 201), specifically employed when an individual has not been successfully examined by a healthcare professional despite diligent efforts. It facilitates a legal pathway to ensure that an individual who may be facing mental health challenges can receive timely and appropriate evaluation by a professional. The form allows a petitioner to request the court's intervention to have the individual examined at a preadmission screening unit or, if necessary, transported to the facility by a peace officer. The process underscores the commitment to both the welfare of the individual and the community, seeking a balance between autonomy and protection. Enshrined in legal safeguards, the document requires a declaration under the penalties of perjury, ensuring the veracity of the petitioner's efforts and intentions. Furthermore, the form sets the stage for judicial determination regarding the reasonableness and compliance of the application with the Mental Health Code, emphasizing a structured approach to what can often be urgent and sensitive situations. It is a vivid example of how law and healthcare converge, aiming to provide a structured yet compassionate response to situations where mental health concerns necessitate legal intervention.

QuestionAnswer
Form NameForm Pcm 209 Michigan
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespetitioner, pcm 201 michigan, PCM, MCL

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Approved, SCAO

JIS CODE: SPA

STATEOFMICHIGAN PROBATECOURT COUNTYOF

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

Attorney name (type or print)

Bar no.

 

 

Address

 

 

 

City, state, zip

Telephone no.

Signature of petitioner

Name (type or print)

Address

City, state, zip

 

 

 

 

 

 

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.

 

 

8.

A peace officer shall take the individual into protective custody and immediately transport him or her to the designated

 

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.

Date

9.

The petition is denied.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

Judge

Bar no.

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 330.1428, MCL 330.1429

PCM 209 (9/13) SUPPLEMENTAL PETITION TO APPLICATION FOR HOSPITALIZATION AND ORDER FOR EXAMINATION

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The way to complete SUPPLEMENTAL portion 1

2. Your next stage is usually to fill out these blanks: Address, City state zip, THE COURT FINDS The application, Address, Telephone no, City state zip, ORDER, is was, is not was not, reasonable and in full compliance, It is necessary that a peace, designated preadmission screening, There does not appear to be, IT IS ORDERED, and The individual be examined at the.

SUPPLEMENTAL writing process clarified (step 2)

Concerning City state zip and It is necessary that a peace, be sure that you take another look here. The two of these are surely the key ones in the document.

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