Free pc629.pmd - Michigan

Approved, SCAO

JIS CODE: GAL, LPH, OMP

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

FILE NO. ORDER APPOINTING PHYSICIAN/VISITOR/ MENTAL HEALTH PROFESSIONAL

In the matter of 1. Date of hearing: Judge:

,

an alleged incapacitated individual an individual alleged to need protection
Bar no.

2. A petition to appoint a guardian or conservator for the individual has been filed and will be heard on at
Date Time

at
Location

.

3. It appears to the court that be appointed. 4. IT IS ORDERED:
Name (type or print) Address City, state, zip

an examining physician

a visitor

an examining mental health professional

should

Telephone no.

is appointed examining physician the attached petition. 5.

visitor

examining mental health professional

for the proceedings on

a. The visitor shall file a written report with recommendations on or before the hearing specified in item 2. b. The physician or mental health professional shall file a written report with recommendations at least 5 days before the hearing specified in item 2. 6. The visitor/physician/mental health professional shall be present at the hearing specified in item 2.

Date

Judge

Do not write below this line - For court use only

PC 629 (9/07)

ORDER APPOINTING PHYSICIAN/VISITOR/MENTAL HEALTH PROFESSIONAL

MCL 700.5304, MCL 700.5310(4), MCL 700.5406, MCR 5.121, MCR 5.405(A)