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)