Order For Substance Abuse Evaluation {MC 211}

Original - Court 2nd copy - Probation officer Approved, SCAO 1st copy - Agency 3rd copy - Defendant STATE OF MICHIGAN CASE NO. JUDICIAL DISTRICT ORDER FOR JUDICIAL CIRCUIT SUBSTANCE ABUSE EVALUATION Court address Court telephone no. Defendants name, address, and telephone no. The State of Michigan THE PEOPLE OF v The defendant in this case was convicted of an alcohol/controlled substance offense. On the date of the arrest, , the defendants breath alcohol content was .IT IS ORDERED: 1. The defendant, at his/her own cost, shall have a substance abuse screening and assessment by Agency name and address to determine whether the defendant will benefit from rehabilitative services. The agency shall submit a written report to the court by . Date 2. If the defendant is on bond he/she shall report to the named agency for evaluation by . Date If the defendant fails to report by the above date for evaluation, the court may issue a bench warrant for his/her arrest. 3. Failure to appear for the evaluation may result in sentencing without the benefit of the evaluation. 4. If the defendant is in jail, the evaluation shall be performed either at the jail or at the named agency. Date Judge/Magistrate ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received a copy of this order for evaluation on . Date Defendant NOTICE OF MAILING BY COURT A copy of this order was mailed to/personally served on the named agency on . Date Date Signature and title MCL 257.624a(3); MSA 9.2324(1)(3), MCL 257.624b(1); MSA 9.2324(2)(1), MCL 257.625b(5); MSA 9.2325(2)(5),MC 211 (6/99) ORDER FOR SUBSTANCE ABUSE EVALUATION MCL 333.7408a(3); MSA 14.15(7408a)(3), MCL 436.1703(1)(a)