Petition For Release From Confinement {PC-806}

CONNECTICUT PROBATE COURTS Petition for Release rom Confinement (Adult) PC-806 REV. 4/19 CONFIDENTIAL Petition for Release from Confinement (Adult) PC - 806 RECEIVED: Instructions: 1) Any person who is subject to a Probate Court order for invo luntary confinement in a hospital for psychiatric disabilities, or his or her representative, may use this form to request release from confinement. 2)For more information, see C.G.S. sections 17a-510.3)Type or print the form in ink. Use an additional sheet, or PC-180, if more space is needed Probate Court Name District Number Respondent (Name and address) Respondent222s Representative Title or Relationship Hospital for psychiatric disabilities in which the respondent is confined: (Name and address) Parties to Whom Notice Should Be Given: (Name, address and relationship) I hereby petition for release under C.G.S. section 17a-510 from involuntary confinement at the above hospital for the treatment of psychiatric disabilities. I understand that: The hearing must be held within 10 days of receipt of this petition by the court.I have the right to be present at the hearing, submit evidence, and to cross examine all witnesses who testify.I have a right to be represented by an attorney. If I cannot pay for an attorney, an attorney will be provided at thestate222s expense, and I may request a specific attorney to represent me.Signature of Respondent or Representative Type or Print Name Date Court Use only Date Request Received by Court American LegalNet, Inc. www.FormsWorkFlow.com