Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - 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 OF ABSENCE FROM TREATMENT FACILITY

To: Superior Court at _______________________ , Respondent's Attorney , Respondent's Guardian or Family , Attorney General , Person previously threatened by the Respondent

You are hereby given notice that the above-named respondent has been absent without permission since _____________________, 20____. This facility shall notify you promptly of his/her return to the facility.

Date

Signature ___________________________________ Print Name ___________________________________ Title

I certify that on _______________________ a copy of this notice was sent to (list names):

By: _________________________________ Treatment Facility Personnel MC-430 (3/01)(st.4) NOTICE OF ABSENCE FROM TREATMENT FACILITY AS 47.30.790 & .805(b)