Fill and Sign the Findings and Custody Order Involuntary Commitment 302a Form

The Respondent was discharged from a 24-hour facility in accordance with G.S. 122C-205.1(b). b. A Substance Abuse Commitment Order was entered in this proceeding on t he date shown above. The period of substance abuse commitment has not expired. 1. The area facility or physician responsible for management and supervision of the Respondent's commitment prescribed treatment on an outpatient basis; the Respondent failed to comp ly with all or part of the prescribed treatment after reasonable efforts to solicit the Respondent's compliance, in that (Summarize facts showing failure to comply and reasonable a. 2. Physician Representative Of Area Facility (Title) Signature Clerk Of Superior Court Assistant Clerk Of Superior Court Magistrate REQUEST FOR TRANSPORTATION ORDER AND ORDER (COMMITTED SUBSTANCE ABUSER FAILS TO COMPLY WITH TREATMENT OR IS DISCHARGED FROM 24-HOUR FACILITY) STATE OF NORTH CAROLINA File No. In The General Court Of Justice District Court Division County IN THE MATTER OF: G.S. 122C-290(b), -205.1(b) AOC-SP-223, New 7/04 2004 Administrative Office of the Courts Name And Current Address Of Respondent NOTE: Use this form only when (1) the respondent has been committed as a substance abuser after a hearing in district court; (2) the respondent has either (a) failed to comply with all or part of prescribed outpatient treatment or (b) has been discharged from a 24-hour facility after escaping or breaching a condition of his/her release from t he 24-hour facility, and 3) the respondent is to be taken to an area facility or physician for examination. DO NOT use this form in mental health cases. Mental health transportation o rders are: Request For Transportation Order And Order (Outpatient Fails But Does Not Clearly Refuse To Comply With Treatment)," AOC-SP-220; "Notice Of Need For Transportation Order And Order (From One 24-Hour Facility To Another)," AOC-SP-222; "Request For Transportation Order And Order (Outpatient Fails To Appear For Prehea ring Examination)," AOC-SP-224. REQUEST The area facility or physician named below requests that the Clerk of Superior Court or Magistrate enter an order, pursuant to G.S. 122C-290(b), to take the Respondent named above into custody an d to take the Respondent to the area facility or physician designated above for examination. In support of this request, t he undersigned states: efforts to solicit compliance): NOTE: See Side Two for Officer's Return(s). TO ANY LAW ENFORCEMENT OFFICER: You are ORDERED to take the Respondent named above into custody, take the Respondent immediately to the area facility or physician designated above for examination, and to turn the Respo ndent over to the custody of that area facility or physician. ORDER Signature Of Physician Or Representative Of Area Facility Date Name Of Physician Or Representative Of Area Facility Transport To (Name And Address Of Area Facility Or Physician) Date Period Of Commitment Expires Date Of Substance Abuse Commitment Order Date 3. 2. 1.On the date and time shown above, I took the Respondent int o custody. I took the Respondent to the specified area facility or physician and, on the date and time shown above, turned the Respondent over to the custody of that area facility or physician. I DID NOT take the Respondent named above into custody because: In addition to turning the Respondent over to the custody of the specified area facility or physician, I then, at the examiner's request, took the Respondent to the 24-hour facility named below a nd turned the Respondent over to the custody of that 24-hour facility. PM AM PM AM PM AM PM AM PM AM PM AM Date Signature Of Deputy Sheriff Or Law Enforcement Officer Making Return Name Of Deputy Sheriff Or Law Enforcement Officer Making Return (Type Or Print) County Of Sheriff Or City Of Law Enforcement Officer AOC-SP-223, Side Two, New 7/04 2004 Administrative Office of the Courts OFFICER'S RETURN Time Time NOTE: The officer who first takes the Respondent into custody shall turn the Respondent over to the custody of the specif ied area facility or physician. The area facility of physician may release the Respondent or "have the Respondent taken" to a 24-hour facil ity. If the officer who took the Respondent into custody is also officer by whom the Respondent is taken to the 24 hour facility, that officer should complete the "Officer's Return" below by checking both Option #1 and Option #3. If a different officer takes the Respondent to the 24-hour facility, the first officer should complete the "Officer's Return" below by checking only Option #1. The second officer should complete the portion headed "For Use When A Different Officer Takes Respondent To 24-Hour Facility." Name Of Deputy Sheriff Or Law Enforcement Officer Making Return (Type Or Print) County Of Sheriff Or City Of Law Enforcement Officer Signature Of Deputy Sheriff Or Law Enforcement Officer Making Return FOR USE WHEN A DIFFERENT OFFICER TAKES RESPONDENT TO 24-HOUR FACILITY At the examiner's request, I took the Respondent into custody at the specified area facility or physician and took the Respondent to the 24-hour facility named below and turned the Respondent over t o the custody of that 24-hour facility. Time Time Respondent Taken From Area Facility Or Physician Name And Address Of 24-Hour Facility DateRespondent Turned Over To 24-Hour Facility Respondent Turned Over To 24-Hour FacilityDate Date Of Return DateRespondent Taken From Area Facility Or Physician Date Of Return Name And Address Of 24-Hour Facility Time Time DateRespondent Turned Over To Custody Of Area Facility Or Physician DateRespondent Taken Into Custody