Approved, SCAO
JIS CODE: OPI
STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION
ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY
FILE NO.
In the matter of 1. Date of hearing: Judge:
, an individual with a developmental disability
Bar no.
2. The guardian has filed a petition requesting authority to execute an application for admission of the individual to a facility. THE COURT FINDS: 3. Notice of hearing was given to or waived by all interested persons. 4.
Name
is the guardian of the person for the individual named above.
5. From testimony given in open court and from the report and evaluation filed with the court, the individual requires care and services at
Name of facility
.
6. The placement offers appropriate treatment and residential programs to meet the individual's need. 7. There appears to be no less restrictive treatment and residential program available to meet the individual's needs. IT IS ORDERED: 8. The guardian is authorized to execute the necessary application for the temporary administrative admission not to exceed 30 days administrative admission admission of the individual named above to
Name of facility
.
Date
Judge
Do not write below this line - For court use only
PC 665 (9/07)
ORDER FOR PLACEMENT OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY
MCL 330.1623, MCR 5.746(B)