Free Microsoft Word - MC-425 Notice to Outpatient to Return to Treatment Facilit... - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity for the Hospitalization of: , Respondent. ) ) ) ) ) )

Case No. NOTICE TO OUTPATIENT TO RETURN TO TREATMENT FACILITY WHERE COMMITTED

To:

It has been determined that you can no longer be treated at as an outpatient because you are likely to cause harm to yourself or others or are gravely disabled. You must return to the treatment facility to which you were committed, , at Alaska, within 24 hours after you receive this notice.

Date

Signature of Provider of Outpatient Care Printed Name Title

I certify that on _________________ a copy of this notice was mailed or delivered to: court respondent respondent's attorney attorney general respondent's guardian (if any) inpatient treatment facility:

By: Outpatient Care Provider
MC-425 (12/87)(cs) NOTICE TO OUTPATIENT TO RETURN TO TREATMENT FACILITY WHERE COMMITTED AS 47.30.795(c)