Order Appointing Physician Visitor Mental Health Professional {PC 629}

Approved, SCAO OSM CODE: G AL, LPH, OMP STATE OF MICHIGAN FILE NO. PROBATE COURT ORDER APPOINTING PHYSICIAN/VISITOR/ COUNTY MENTAL HEALTH PROFESSIONAL CIRCUIT COURT - FAMILY DIVISION an alleged incapacitated individual In the matter of , an indivdual ialleged to need protection1. Date of hearing: Judge: Bar no.2. A petition to appoint a guardian or conservator for the individual has been filed and will be heard on at at . Date Time Location an examining physician 3. It appears to the court that a visitor should be appointed. an examining mental health professional 4. IT IS ORDERED : is appointed examining physician Name (type or print) visitor examining mental health professional Address City, state, zip Telephone no. for the proceedings on the attached petition. 5. a. The visitor shall file a written report with recommendations on or before the hearing specified in item 2. b. The physician or mental health professional shall file a written report with recommendations at least five days before the hearing specified in item 2. 6. The physician/visitor/mental health professional shall be present at the hearing specified in item 2. Date Judge Do not write below this line - For court use only MCL 700.5304; MSA 27.15304, MCL 700.5310(4); MSA 27.15310(4), MCL 700.5406; MSA 27.15406, MCR 5.121, MCR 5.405(A)PC 629 (3/00) ORDER APPOINTING PHYSICIAN/VISITOR/MENTAL HEALTH PROFESSIONAL