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Fill and Sign the Form Mc 410 Download Fillable PDF Notice of Release

Fill and Sign the Form Mc 410 Download Fillable PDF Notice of Release

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INSTRUCTIONS FOR EVALUATION FACILITY: This form shall be filed with the court immediately upon the respondent’s release. MC -410 ( 8/18 )(cs) AS 47.30.720 ; AS 47.30.725(b) ; NOTICE OF RELEASE AS 47.30.780 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Necessity ) for the Hospitalization of: ) ) , ) Case No. Respondent. ) Date of Birth: ) ) NOTICE OF RELEASE To: Superior Court at , Alaska. The court ordered that the respondent be hospitalized for evaluation at one of the facilities below. Pursuant to that order, the res pondent w a s de l i v e r e d to th e following facility on : Alas ka Ps ych iatric Institute Peace Health Ketch ikan Medical Center Bartlett Regional Hos pital Yukon-Kuskokwim Delta Reg. Hos pital Fairbanks Memo rial Hospital Ot her The above facility released the respondent on , at am pm. Reason for Release: Qualified personnel at the above facility determined that the r espondent no longer meets the criteria for hospitalization or commitment . The court denied the 30/90/180 -day petition for commitment in this case. Date Signature Print Name and Title Phone Number E-mail address I certify that on , a copy of this notice was provided to: respondent parent/guardian PDA AGO By Clerk:

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