Fill and Sign the Answering Brief and Cross Opening Brief with Ser 1 49 Form

GN-4 07 0, 1 0/0 6 N otic e o f In it ia l P la ce m ent b y A ppro pria te B oa rd o r D esig n ate d A gen cy §55 .1 2 (2 ), W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. S TA TE O F W IS C O NSIN , C IR CUIT C O URT, C O UNTY IN T H E M ATTE R O F A m en ded N otic e o f I n it ia l P la ce m en t b y A ppro pria te B oard o r D esig nate d A gen cy D ate o f B ir th C ase N o. For O ff ic ia l U se P la ce m ent o f th e in div id u al is b e in g m ade o r h as b een m ade o n , 2 0 a t th e f o ll o w in g lo ca tio n : (N am e, a d dre s s, t e le p ho ne n um ber o f p la cem en t u nit :) T his p la ce m ent u nit is : u nlo ck e d u nit . lo ck e d u nit . T he t y p e o f p la ce m ent u n it is : n urs in g f a cili t y . in te rm edia te c a re f a cil it y . c e nte r f o r th e d e ve lo pm enta ll y d is a b le d. p ub lic m edic a l in stit u tio n . f o ste r c a re s e rv ic e s. a du lt f a m il y h om e. g ro up h om e. a partm ent. f a cilit y p ro vid in g a cu te p syc h ia tr ic tr e atm ent . o th er n on-in stit u tio na l c o m munit y s e ttin g. In d iv id u al h as a d e ve lo pm enta l d is a b il it y . Sig natu re Nam e P rin te d o r T yp ed Id e ntit y o f B oard o r D esig nate d A ge ncy Date