Free mc211.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Agency

2nd copy - Probation officer 3rd copy - Defendant

STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT
Court address

CASE NO. ORDER FOR SUBSTANCE ABUSE EVALUATION
Court telephone no.

The State of Michigan THE PEOPLE OF v

Defendant's name, address, and telephone no.

The defendant in this case was convicted of an alcohol/controlled substance offense. On the date of the arrest,
Date

, the defendant's breath-alcohol content was

.

IT IS ORDERED: 1. The defendant, at his/her own cost, shall have a substance abuse screening and assessment by

Agency name and address

to determine whether the defendant will benefit from rehabilitative services. The agency shall submit a written report to the court by
Date

. .
Date

2. If the defendant is on bond, he/she shall report to the named agency for evaluation by If the defendant fails to report by the above date for evaluation, the court may issue a bench warrant for his/her arrest. 3. Failure to appear for the evaluation may result in sentencing without the benefit of the evaluation. 4. If the defendant is in jail, the evaluation shall be performed either at the jail or at the named agency.

Date

Judge/Magistrate

ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received a copy of this order for evaluation on
Date Defendant

.

NOTICE OF MAILING BY COURT A copy of this order was mailed to/personally served on the named agency on
Date

.

Date

Signature and title

MC 211 (3/08)

ORDER FOR SUBSTANCE ABUSE EVALUATION

MCL 257.624a(3), MCL 257.624b(1), MCL 257.625b(5), MCL 333.7408a(3), MCL 436.1703(1)(a)