Fill and Sign the Gn 3110 Order and Notice of Hearing Wisconsin Court Form

GN -4400 , 05/17 Order on Petition to Modify Protective Placement or Protective Services §§46.279 (2) and 55.16, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Amended Order on Petition to Modify Protective Placement or Protective Services Date of Birth Case No. This matter is before the court on a petition to modify an order for protective placement. protective services (other than an order for involuntary administration of psychotropic me dication) . A hearing has not been held within the previous 6 months on court -ordered protective placement, court -ordered protective services or transfer of protective placement. A hearing has been held on the petition for modification of protective placement or protective services within 21 days after filing the petition, unless the individual, individual’s guardian, gua rdian a d litem, or attorney has requested an extension. The court has reviewed the testimony, reports, community plan (if applicable) , other evidence presented and the report and recommendation of the guardian ad litem. THE COURT FINDS: 1. NOTICE AND JURISDICTION A. Notice was properly served. B. This court has jurisdiction of the subject matter and of the person of the individual. 2. PROTECTIVE PLACEMENT A. Continuation: The individual continues to meet the standards f or protective placement under § 55.08 (1) , W is. Stats., and the individual’s protective placement is in the least restrictive environment and least restrictive manner consis tent with the requirements of § 55.12 (3), (4), and (5), W is. Stats., and protective placement is in the most integrated setting if the individual has a developmental disability and placement is in a nursing facility or intermediate care facility. B. Modification: The i ndividual continues to meet the standards f or protective placement under § 55.08 (1), W is. Stats., but the protective placement is not in the least restrictive environment that is consis tent with the requirements of § 55.12 (3), (4), and (5), W is. Stats., or protective placement is not in the most integrated setting if the individual has a developmental disability and placement is in a nursing facility or intermediate care facility. C. Termination: The individual no longer meets the standards for protective placement under § 55.08 (1) , Wis. Stats . The individual needs protective services and meets the standards for protective services as follows: (1) The individual has been determined to be incompetent by a circuit court or is a minor who is alleged to have a developmental disability and on whose behalf a petition for guardianship has been submitted; and Order on Petition to Modify Protective Placement or Protective Services Page 2 of 3 Case No. GN -4400, 05/17 Order on Petition to Modify Protective Placement or Protective Services §§46.279 (2) and 55.16, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 (2) As a result of a developmental disability , degenerative brain disorder, serious and persistent mental illness, or other like incapacities, the individual will incur a substantial risk of physical harm or deterioration or will present a substantial risk of harm to others if protective services are not provided. 3. PROTECTIVE SERVICE S (Other than order for involuntary administration of psychotropic medication) A. Continuation: The individual continues to meet the standards for protective services under § 55.08 (2 ), W is. Stats., and the current protective services are provided in the least restrictive manner that is consis tent with the requirements of § §55.12 (3), (4), and (5 ), Wis. Stats. B. Modification: The individual continues to meet the standards for protective services under § 55.08 (2), W is. Stats., but the protective services for the individual are not provided in the least restrictive manner that is consis tent with t he requirements of § 55.12 (3), (4), and (5) , W is. Stats . C. Termination: The individual no longer meets the standards for protective services under § 55.08 (2) , Wis. Stats. THE COURT ORDERS : 1. PROTECTIVE PLACEMENT A. Continuation: Protective placement is continued in the facility in which the individual resides at the time of the hearing. B. Modification: The individual is t ransfer red to a protective placement that is in t he least restrictive environment consis tent with the requirements of § 55.12 (3), (4), and (5), W is. Stats. , in the following s pecific facility : The county department of the individual’s residence to develop or recommend a protective placement that is in the least restrictive environment and arrange for the individual’s transfer to that protective placement within 60 days of the date of this order. This time period is extend ed to permit development of a protective placement as follows: Protective services sha ll be provided . C. Termination: The protective placement is terminated. (1) The individual shall be transferred or discharged fr om his/her current residential facility within 60 days of this order. The county department shall assist the residential facility with discharge planning for the individual including planning for proper residential living arrangements and the necessary sup port services for the individual. (2) The individual may remain in the current facility, which is licensed for fewer than 16 beds. (3) The county department or agency with which is contracts under § 55.02(2), Wis. Stat s., or its designee shall provide protective services to the individual in the least restrictive environment and in the least restri ctive manner consistent with the needs of the individual and with the resources of the county department. 2. PROTECTIVE SERVICES A. Continuation: The order for protective services is continued. B. Modification: Protective services consis tent with the requirements of § 55.06 (3), (4), and (5), Wis. Stats., shall be provided as follows: Order on Petition to Modify Protective Placement or Protective Services Page 3 of 3 Case No. GN -4400, 05/17 Order on Petition to Modify Protective Placement or Protective Services §§46.279 (2) and 55.16, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 C. Termination: The order for protective services is terminated. THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL. BY THE COURT: Name of Attorney Circuit Court Judge/ Circuit Court Commissioner Print or Type Name if not eSigned Date Address Telephone Number Bar Number