Authorization And Order To Return Escaped Patient To Mental Health Facility {INV 39}

NOTICE TO RETURN ESCAPEE TO MENTAL HEALTH FACILITY IN RE: Involuntary Hospitalization of Case No. ________- MH -________ ___________________________________ RESPONDENT AUTHORIZATION AND ORDER: TO RETURN ESCAPED PATIENT TO MENTAL HEALTH FACILITY [W.Va. Code: §27-7-5] TO THE SHERIFF OF ______________________ COUNTY, WEST VIRGINIA: Pursuant to the provisions of West Virginia Code: § 27-7-5, YOU ARE HEREBY COMMANDED to take into custody and to transport back to the ______________________________________________________________________________________ mental health facility the following patient who has escaped therefrom: Name of Patient: Patient's Description: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________________________________ Patient's Last Known Address: ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ A person who is taken into custody under this notice and the provisions of West Virginia Code: § 27-7-5, may be detained, but not incarcerated in a jail or penal institution, for a period not in excess of fourteen (14) hours, pending return to the mental health facility named above. Pursuant to West Virginia Code: § 27-7-5, THE SHERIFF MAY EXECUTE THIS ORDER IN ANY PART OF THE STATE OF WEST VIRGINIA. Given under my hand this _________ day of ______________________________________, 2 _______. ____________________________________________________________ CHIEF MEDICAL OFFICER OF FACILITY C CL MH07 INV 39 American LegalNet, Inc. www.FormsWorkFlow.com