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Free Pcm 209 Michigan Template in PDF

The PCM 209 Michigan form serves as a legal document utilized in the probate court system to request an examination of an individual for potential hospitalization. This form facilitates the process by which a petitioner can seek a court order for a mental health evaluation, particularly when efforts to have the individual examined by a physician or psychologist have been unsuccessful. Through this petition, the court can determine the necessity of protective custody and the appropriate steps for ensuring the individual's mental health needs are addressed.

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Structure

The PCM 209 form is a crucial document utilized within Michigan's probate court system, specifically designed to facilitate the process of involuntary hospitalization for individuals in need of mental health evaluation. This form serves as a supplemental petition to the Application for Hospitalization, allowing petitioners to request that the court order an examination of an individual who may be experiencing a mental health crisis. In instances where a petitioner has made reasonable efforts to secure a medical examination but has been unsuccessful, the form outlines the necessary steps to seek judicial intervention. It provides options for the court to order the individual to be examined at a designated preadmission screening unit or to authorize a peace officer to take the individual into protective custody for transport to that unit. The form also includes a declaration of truthfulness under penalty of perjury, ensuring accountability in the petitioning process. The court's findings and subsequent orders are clearly delineated within the form, addressing the reasonableness of the application and the necessity for immediate action. This structured approach aims to balance the rights of individuals with the imperative of ensuring their safety and well-being during critical moments.

Form Example

Approved, SCAO

JIS CODE: SPA

STATEOFMICHIGAN PROBATECOURT COUNTYOF

SUPPLEMENTAL PETITION TO

APPLICATION FOR HOSPITALIZATION

AND ORDER FOR EXAMINATION

FILE NO.

In the matter of

PETITION

1.I executed the attached Application for Hospitalization (PCM 201). I have been unable to have the individual examined by a physician or licensed psychologist although I have made the following efforts:

2.I request the court to order

a.the individual to be examined at

the preadmission screening unit designated by the community mental health services program.

b. a peace officer to take the individual into protective custody and transport him/her to the preadmission screening unit named above for the examination.

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Date

Attorney name (type or print)	Bar no.

Address

City, state, zip	Telephone no.

Signature of petitioner

Name (type or print)

Address

City, state, zip

					ORDER
THE COURT FINDS:
THE COURT FINDS:
3. The application		is	is not	reasonable and in full compliance with section 424 of the Mental Health Code.
4. A reasonable effort		was	was not	made to secure an examination.
5.	It is necessary that a peace officer take the individual into protective custody and immediately transport him or her to the
	designated preadmission screening unit for the examination.
6.	There does not appear to be probable cause to take action on this petition.
IT IS ORDERED:
7.	The individual be examined at the designated preadmission screening unit.
8.	A peace officer shall take the individual into protective custody and immediately transport him or her to the designated
	preadmission screening unit provided that the individual is presented for examination by							,
	which is within 10 days of the date of execution of the application.						Date
9.	The petition is denied.

Date						Judge	Bar no.

USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form.

Do not write below this line - For court use only

MCL 330.1428, MCL 330.1429

PCM 209 (9/13) SUPPLEMENTAL PETITION TO APPLICATION FOR HOSPITALIZATION AND ORDER FOR EXAMINATION

▼ Pcm 209 Michigan PDF Form

Document Specs

Fact Name	Details
Purpose of the Form	The PCM 209 form is used to petition the court for the hospitalization of an individual who may require mental health evaluation and treatment.
Governing Laws	This form is governed by the Michigan Mental Health Code, specifically MCL 330.1428 and MCL 330.1429.
Examination Request	The petitioner can request that the court order an examination at a designated preadmission screening unit or for a peace officer to take the individual into protective custody.
Verification of Information	The petitioner must declare under penalty of perjury that the information provided in the petition is true to the best of their knowledge and belief.

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